Folate and restenosis
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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
On Thu, 24 Jun 2004 01:04:08 GMT, Jim Chinnis
<jchinnis@SPAMalum.mit.edu> wrote:
>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" <jchinnis@SPAMalum.mit.edu> wrote in message
news:us9kd01v7fsl37fknrjm6t8ai79jt0tppl@4ax.com...
> 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 wrote:
>
> 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
http://www.heartmdphd.com/
**
Who is the humblest person in the universe?
http://makeashorterlink.com/?L26062048
What is all this about?
http://makeashorterlink.com/?R20632B48
Is this spam?
http://makeashorterlink.com/?N69721867
listener@nospam.net wrote in part:
>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...
>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
>"Jim Chinnis" <jchinnis@SPAMalum.mit.edu> wrote in message
>news:us9kd01v7fsl37fknrjm6t8ai79jt0tppl@4ax.com...
>> 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.
>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" <andrew@heartmdphd.com> wrote in part:
>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
http://www.medscape.com/viewarticle/481573
Bottom line: don't take folates after having stents!
listener@nospam.net wrote in message
news:<g7fkd010rh76t1s883c4jtv8boi978hj4a@4ax.com>...
> On Thu, 24 Jun 2004 01:04:08 GMT, Jim Chinnis
> <jchinnis@SPAMalum.mit.edu> wrote:
>
> >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.
On Thu, 24 Jun 2004 03:09:51 GMT, Jim Chinnis
<jchinnis@SPAMalum.mit.edu> wrote:
>listener@nospam.net wrote in part:
>
>>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...
>
>>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.
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