Randomized controlled trial of homocysteine-lowering vitamin treatment in elderly patients with vascular disease

Stott, D.J. et al. (2005) Randomized controlled trial of homocysteine-lowering vitamin treatment in elderly patients with vascular disease. American Journal of Clinical Nutrition, 82, pp. 1320-1326.

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Abstract

Background: Homocysteine is an independent risk factor for vascular disease and is associated with dementia in older people. Potential mechanisms include altered endothelial and hemostatic function. Objective: We aimed to determine the effects of folic acid plus vitamin B-12, riboflavin, and vitamin B-6 on homocysteine and cognitive function. Design: This was a factorial 2 x 2 x 2, randomized, placebo-controlled, double-blind study with 3 active treatments: folic acid (2.5 mg) plus vitamin B-12 (500 µg), vitamin B-6 (25 mg), and riboflavin (25 mg). We studied 185 patients aged ≥65 y with ischemic vascular disease. Outcome measures included plasma homocysteine, fibrinogen, and von Willebrand factor at 3 mo and cognitive change (determined with the use of the Letter Digit Coding Test and on the basis of the Telephone Interview of Cognitive Status) after 1 y. Results: The mean (±SD) baseline plasma homocysteine concentration was 16.5 ± 6.4 µmol/L. This value was 5.0 (95% CI: 3.8, 6.2) µmol/L lower in patients given folic acid plus vitamin B-12 than in patients not given folic acid plus vitamin B-12 but did not change significantly with vitamin B-6 or riboflavin treatment. Homocysteine lowering with folic acid plus vitamin B-12 had no significant effect, relative to the 2 other treatments, on fibrinogen, von Willebrand factor, or cognitive performance as measured by the Letter Digit Coding Test (mean change: –1; 95% CI: –2.3, 1.4) and the Telephone Interview of Cognitive Status (–0.7; 95% CI: –1.7, 0.4). Conclusion: Oral folic acid plus vitamin B-12 decreased homocysteine concentrations in elderly patients with vascular disease but was not associated with statistically significant beneficial effects on cognitive function over the short or medium term.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Macfarlane, Professor Peter and MacIntosh, Mr Graham and Stott J, Professor David and McMahon, Dr Alex and Rumley, Dr Ann and Langhorne, Professor Peter
Authors: Stott, D.J., MacIntosh, G., Do Lowe, G., Rumley, A., McMahon, A., Langhorne, P., Tait, R.C., O'Reilly, D.S., Spilg, E.G., MacDonald, J.B., Macfarlane, P.W., and Westendorp, R.G.J.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:American Journal of Clinical Nutrition
Journal Abbr.:Am. j. clin. nutr.
ISSN:0002-9165
ISSN (Online):1938-3207

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