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High-dose B vitamin supplementation and progression of subclinical atherosclerosis: a randomized controlled trial.
Stroke 2009; 40(3):730-6S

Abstract

BACKGROUND AND PURPOSE

Although plasma total homocysteine (tHcy) levels are associated with cardiovascular disease, it remains unclear whether homocysteine is a cause or a marker of atherosclerotic vascular disease. We determined whether reduction of tHcy levels with B vitamin supplementation reduces subclinical atherosclerosis progression.

METHODS

In this double-blind clinical trial, 506 participants 40 to 89 years of age with an initial tHcy >8.5 micromol/L without diabetes and cardiovascular disease were randomized to high-dose B vitamin supplementation (5 mg folic acid+0.4 mg vitamin B(12)+50 mg vitamin B(6)) or matching placebo for 3.1 years. Subclinical atherosclerosis progression across 3 vascular beds was assessed using high-resolution B-mode ultrasonography to measure carotid artery intima media thickness (primary outcome) and multidetector spiral CT to measure aortic and coronary artery calcium (secondary outcome).

RESULTS

Although the overall carotid artery intima media thickness progression rate was lower with B vitamin supplementation than with placebo, statistically significant between-group differences were not found (P=0.31). However, among subjects with baseline tHcy >or=9.1 micromol/L, those randomized to B vitamin supplementation had a statistically significant lower average rate of carotid artery intima media thickness progression compared with placebo (P=0.02); among subjects with a baseline tHcy <9.1 micromol/L, there was no significant treatment effect (probability value for treatment interaction=0.02). B vitamin supplementation had no effect on progression of aortic or coronary artery calcification overall or within subgroups.

CONCLUSIONS

High-dose B vitamin supplementation significantly reduces progression of early-stage subclinical atherosclerosis (carotid artery intima media thickness) in well-nourished healthy B vitamin "replete" individuals at low risk for cardiovascular disease with a fasting tHcy >or=9.1 micromol/L.

Authors+Show Affiliations

Atherosclerosis Research Unit, Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, Calif. 90033, USA. athero@usc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

19118243

Citation

Hodis, Howard N., et al. "High-dose B Vitamin Supplementation and Progression of Subclinical Atherosclerosis: a Randomized Controlled Trial." Stroke, vol. 40, no. 3, 2009, pp. 730-6.
Hodis HN, Mack WJ, Dustin L, et al. High-dose B vitamin supplementation and progression of subclinical atherosclerosis: a randomized controlled trial. Stroke. 2009;40(3):730-6.
Hodis, H. N., Mack, W. J., Dustin, L., Mahrer, P. R., Azen, S. P., Detrano, R., ... Selzer, R. H. (2009). High-dose B vitamin supplementation and progression of subclinical atherosclerosis: a randomized controlled trial. Stroke, 40(3), pp. 730-6. doi:10.1161/STROKEAHA.108.526798.
Hodis HN, et al. High-dose B Vitamin Supplementation and Progression of Subclinical Atherosclerosis: a Randomized Controlled Trial. Stroke. 2009;40(3):730-6. PubMed PMID: 19118243.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-dose B vitamin supplementation and progression of subclinical atherosclerosis: a randomized controlled trial. AU - Hodis,Howard N, AU - Mack,Wendy J, AU - Dustin,Laurie, AU - Mahrer,Peter R, AU - Azen,Stanley P, AU - Detrano,Robert, AU - Selhub,Jacob, AU - Alaupovic,Petar, AU - Liu,Chao-ran, AU - Liu,Ci-hua, AU - Hwang,Juliana, AU - Wilcox,Alison G, AU - Selzer,Robert H, AU - ,, Y1 - 2008/12/31/ PY - 2009/1/2/entrez PY - 2009/1/2/pubmed PY - 2009/3/21/medline SP - 730 EP - 6 JF - Stroke JO - Stroke VL - 40 IS - 3 N2 - BACKGROUND AND PURPOSE: Although plasma total homocysteine (tHcy) levels are associated with cardiovascular disease, it remains unclear whether homocysteine is a cause or a marker of atherosclerotic vascular disease. We determined whether reduction of tHcy levels with B vitamin supplementation reduces subclinical atherosclerosis progression. METHODS: In this double-blind clinical trial, 506 participants 40 to 89 years of age with an initial tHcy >8.5 micromol/L without diabetes and cardiovascular disease were randomized to high-dose B vitamin supplementation (5 mg folic acid+0.4 mg vitamin B(12)+50 mg vitamin B(6)) or matching placebo for 3.1 years. Subclinical atherosclerosis progression across 3 vascular beds was assessed using high-resolution B-mode ultrasonography to measure carotid artery intima media thickness (primary outcome) and multidetector spiral CT to measure aortic and coronary artery calcium (secondary outcome). RESULTS: Although the overall carotid artery intima media thickness progression rate was lower with B vitamin supplementation than with placebo, statistically significant between-group differences were not found (P=0.31). However, among subjects with baseline tHcy >or=9.1 micromol/L, those randomized to B vitamin supplementation had a statistically significant lower average rate of carotid artery intima media thickness progression compared with placebo (P=0.02); among subjects with a baseline tHcy <9.1 micromol/L, there was no significant treatment effect (probability value for treatment interaction=0.02). B vitamin supplementation had no effect on progression of aortic or coronary artery calcification overall or within subgroups. CONCLUSIONS: High-dose B vitamin supplementation significantly reduces progression of early-stage subclinical atherosclerosis (carotid artery intima media thickness) in well-nourished healthy B vitamin "replete" individuals at low risk for cardiovascular disease with a fasting tHcy >or=9.1 micromol/L. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/19118243/High_dose_B_vitamin_supplementation_and_progression_of_subclinical_atherosclerosis:_a_randomized_controlled_trial_ L2 - http://www.ahajournals.org/doi/full/10.1161/STROKEAHA.108.526798?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -