Folate and restenosis

Jim Chinnis said:

Any comments on the following? I may drop my folate, B6,
B12 pills!
*******************

New England Journal of Medicine, Volume 350:2673-2681 June
24, 2004 Number 26

Folate Therapy and In-Stent Restenosis after Coronary
Stenting

Helmut Lange, M.D., Harry Suryapranata, M.D., Giuseppe De
Luca, M.D., Caspar Börner, M.D., Joep Dille, B.Sc., Klaus
Kallmayer, M.D., M. Noor Pasalary,
M.D., Eberhard Scherer, M.D., and Jan-Henk E.
Dambrink, M.D.

ABSTRACT

Background Vitamin therapy to lower homocysteine levels has
recently been recommended for the prevention of restenosis
after coronary angioplasty. We tested the effect of a
combination of folic acid, vitamin B6, and vitamin B12
(referred to as folate therapy) on the risk of angiographic
restenosis after coronary-stent placement in a double-
blind, multicenter trial.

Methods A total of 636 patients who had undergone
successful coronary stenting were randomly assigned to
receive 1 mg of folic acid, 5 mg of vitamin B6, and 1 mg of
vitamin B12 intravenously, followed by daily oral doses of
1.2 mg of folic acid, 48 mg of vitamin B6, and 60 µg of
vitamin B12 for six months, or to receive placebo. The
angiographic end points (minimal luminal diameter, late
loss, and restenosis rate) were assessed at six months by
means of quantitative coronary angiography.

Results At follow-up, the mean (±SD) minimal luminal
diameter was significantly smaller in the folate group than
in the placebo group (1.59±0.62 mm vs. 1.74±0.64 mm,
P=0.008), and the extent of late luminal loss was greater
(.90±0.55 mm vs. 0.76±0.58 mm, P=0.004). The restenosis
rate was higher in the folate group than in the placebo
group (34.5 percent vs. 26.5 percent, P=0.05), and a higher
percentage of patients in the folate group required
repeated target-vessel revascularization (15.8 percent vs.
10.6 percent, P=0.05). Folate therapy had adverse effects
on the risk of restenosis in all subgroups except for
women, patients with diabetes, and patients with markedly
elevated homocysteine levels (15 µmol per liter or more) at
baseline.

Conclusions Contrary to previous findings, the
administration of folate, vitamin B6, and vitamin B12 after
coronary stenting may increase the risk of in-stent
restenosis and the need for target-vessel
revascularization.

Do you know what your homocysteine level was before you
began folate therapy and what it is now?

I'm not sure what to make of this....confusing, for
sure. Why would those with elevated levels not have the
adverse effect?

L.

"Jim Chinnis" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Any comments on the following? I may drop my folate, B6,
B12 pills!
*******************

Of course, as I'm sure you know, the mechanism for
restenosis is different than arteriosclerosis and the
origional blockage. I think after 6 months to a year after
an operation you are unlikely to get restenosis. So I am not
sure what to make of this

Bill

Jim Chinnis said:

Any comments on the following? I may drop my folate, B6,
B12 pills!
*******************

New England Journal of Medicine, Volume 350:2673-2681 June
24, 2004 Number 26

Folate Therapy and In-Stent Restenosis after Coronary
Stenting

Helmut Lange, M.D., Harry Suryapranata, M.D., Giuseppe De
Luca, M.D., Caspar Börner, M.D., Joep Dille, B.Sc., Klaus
Kallmayer, M.D., M. Noor Pasalary,
M.D., Eberhard Scherer, M.D., and Jan-Henk E. Dambrink,
M.D.

ABSTRACT

Background Vitamin therapy to lower homocysteine levels
has recently been recommended for the prevention of
restenosis after coronary angioplasty. We tested the
effect of a combination of folic acid, vitamin B6, and
vitamin B12 (referred to as folate therapy) on the risk of
angiographic restenosis after coronary-stent placement in
a double-blind, multicenter trial.

Methods A total of 636 patients who had undergone
successful coronary stenting were randomly assigned to
receive 1 mg of folic acid, 5 mg of vitamin B6, and 1 mg
of vitamin B12 intravenously, followed by daily oral doses
of 1.2 mg of folic acid, 48 mg of vitamin B6, and 60 µg of
vitamin B12 for six months, or to receive placebo. The
angiographic end points (minimal luminal diameter, late
loss, and restenosis rate) were assessed at six months by
means of quantitative coronary angiography.

Results At follow-up, the mean (±SD) minimal luminal
diameter was significantly smaller in the folate group
than in the placebo group (1.59±0.62 mm vs. 1.74±0.64 mm,
P=0.008), and the extent of late luminal loss was greater
(.90±0.55 mm vs. 0.76±0.58 mm, P=0.004). The restenosis
rate was higher in the folate group than in the placebo
group (34.5 percent vs. 26.5 percent, P=0.05), and a
higher percentage of patients in the folate group required
repeated target-vessel revascularization (15.8 percent vs.
10.6 percent, P=0.05). Folate therapy had adverse effects
on the risk of restenosis in all subgroups except for
women, patients with diabetes, and patients with markedly
elevated homocysteine levels (15 µmol per liter or more)
at baseline.

Conclusions Contrary to previous findings, the
administration of folate, vitamin B6, and vitamin B12
after coronary stenting may increase the risk of in-stent
restenosis and the need for target-vessel
revascularization.
--
Jim Chinnis Warrenton, Virginia, USA

There may be a problem with the intravenous "loading" of
folate, B12, and B6 at the time of the stenting (when there
is injury to the artery and rapid proliferation of vessel
wall elements that lead to restenosis). This is *not* what
is typically done to prevent restenosis.

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

**
Who is the humblest person in the universe?
makeashorterlink.commakeashorterlink.comOpen ↗

What is all this about?
makeashorterlink.commakeashorterlink.comOpen ↗

Is this spam?
makeashorterlink.commakeashorterlink.comOpen ↗

[email hidden] wrote in part:

Quoted message said:

Do you know what your homocysteine level was before you
began folate therapy and what it is now?

Around 13 and around 11.5, respectively...

Quoted message said:

I'm not sure what to make of this....confusing, for
sure. Why would those with elevated levels not have the
adverse effect?

Those with very high homocysteine may benefit from the
homocysteine lowering. When homocysteine levels are more
normal, there may be some other negative effect from the
vitamins that overshadows the homocysteine-lowering benefit
(in men...).

Or...who knows?
--
Jim Chinnis Warrenton, Virginia, USA

Quoted message said:

"Jim Chinnis" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Any comments on the following? I may drop my folate, B6,
B12 pills!
*******************

Of course, as I'm sure you know, the mechanism for
restenosis is different than arteriosclerosis and the
origional blockage.

Yes, but the same questions seem to apply re the reported
effects of folate therapy.

Quoted message said:

I think after 6 months to a year after an operation you
are unlikely to get restenosis. So I am not sure what to
make of this

Agreed.
--
Jim Chinnis Warrenton, Virginia, USA

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in part:

Quoted message said:

There may be a problem with the intravenous "loading" of
folate, B12, and B6 at the time of the stenting (when there
is injury to the artery and rapid proliferation of vessel
wall elements that lead to restenosis). This is *not* what
is typically done to prevent restenosis.

Makes sense to me. Possible, surely.
--
Jim Chinnis Warrenton, Virginia, USA

For more info, see the Medscape CME activity
medscape.com481573Open ↗

Bottom line: don't take folates after having stents!

[email hidden] wrote in message
news:<[email hidden]>...

Quoted message said:

Jim Chinnis said:

Any comments on the following? I may drop my folate, B6,
B12 pills!
*******************

New England Journal of Medicine, Volume 350:2673-2681
June 24, 2004 Number 26

Folate Therapy and In-Stent Restenosis after Coronary
Stenting

Helmut Lange, M.D., Harry Suryapranata, M.D., Giuseppe De
Luca, M.D., Caspar Börner, M.D., Joep Dille, B.Sc., Klaus
Kallmayer, M.D., M. Noor Pasalary,
M.D., Eberhard Scherer, M.D., and Jan-Henk E. Dambrink,
M.D.

ABSTRACT

Background Vitamin therapy to lower homocysteine levels
has recently been recommended for the prevention of
restenosis after coronary angioplasty. We tested the
effect of a combination of folic acid, vitamin B6, and
vitamin B12 (referred to as folate therapy) on the risk
of angiographic restenosis after coronary-stent placement
in a double-blind, multicenter trial.

Methods A total of 636 patients who had undergone
successful coronary stenting were randomly assigned to
receive 1 mg of folic acid, 5 mg of vitamin B6, and 1 mg
of vitamin B12 intravenously, followed by daily oral
doses of 1.2 mg of folic acid, 48 mg of vitamin B6, and
60 µg of vitamin B12 for six months, or to receive
placebo. The angiographic end points (minimal luminal
diameter, late loss, and restenosis rate) were assessed
at six months by means of quantitative coronary
angiography.

Results At follow-up, the mean (±SD) minimal luminal
diameter was significantly smaller in the folate group
than in the placebo group (1.59±0.62 mm vs. 1.74±0.64 mm,
P=0.008), and the extent of late luminal loss was greater
(.90±0.55 mm vs. 0.76±0.58 mm, P=0.004). The restenosis
rate was higher in the folate group than in the placebo
group (34.5 percent vs. 26.5 percent, P=0.05), and a
higher percentage of patients in the folate group
required repeated target-vessel revascularization (15.8
percent vs. 10.6 percent, P=0.05). Folate therapy had
adverse effects on the risk of restenosis in all
subgroups except for women, patients with diabetes, and
patients with markedly elevated homocysteine levels (15
µmol per liter or more) at baseline.

Conclusions Contrary to previous findings, the
administration of folate, vitamin B6, and vitamin B12
after coronary stenting may increase the risk of in-stent
restenosis and the need for target-vessel
revascularization.

Do you know what your homocysteine level was before you
began folate therapy and what it is now?

I'm not sure what to make of this....confusing, for
sure. Why would those with elevated levels not have the
adverse effect?

L.

Jim Chinnis said:

[email hidden] wrote in part:

Quoted message said:

Do you know what your homocysteine level was before you
began folate therapy and what it is now?

Around 13 and around 11.5, respectively...

Quoted message said:

I'm not sure what to make of this....confusing, for
sure. Why would those with elevated levels not have the
adverse effect?

Those with very high homocysteine may benefit from the
homocysteine lowering. When homocysteine levels are more
normal, there may be some other negative effect from the
vitamins that overshadows the homocysteine-lowering benefit
(in men...).

Or...who knows?

My levels lowered from 22 to 7.5, In do not have cad (so
no stents or
mi) or so I guess I'll continue to take folate. Hopefully
there will be more clarification on this in the future.

L.