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(6), pp. 1320-1326. (doi: 10.1093/ajcn/82.6.1320) (PMID:16332666)

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 Macdonald, Dr Jonathan and Rumley, Dr Ann and Langhorne, Professor Peter and Lowe, Professor Gordon and MacIntosh, Mr Graham and Tait, Dr Robert and Stott J, Professor David and O'Reilly, Dr Denis and McMahon, Dr Alex
• Authors: Stott, D. J., MacIntosh, G., Lowe, G. D.O., Rumley, A., McMahon, A. D., Langhorne, P., Tait, R. C., O'Reilly, D. S. J., Spilg, E., MacDonald, J. B., MacFarlane, P. W., and Westendorp, R. G.J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: American Journal of Clinical Nutrition
• Journal Abbr.: Am. j. clin. nutr.
• Publisher: American Society for Nutrition
• ISSN: 0002-9165
• ISSN (Online): 1938-3207