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Disorders of Lipid Metabolism

DLM: Homocysteine, Folate, B-12 Overview Table (2007)

Homocysteine, Folate, B-12 Overview Table

For a quck comparason of the research we reviewed on homocysteine, folate, and vitamin B, please see the Overview Table.

 

Homocysteine, Folate, B-12: Overview Table

 

Lindeman, 2003

Lee, 2003

Schnyder, 2002

Liem, 2003

Toole, 2004

Bautista, 2002

Hcyt Coll Study

Sample size

n=791

420 men

371 women

60 with CAD

60 references

Hcyt therapy group: 272

Placebo group: 281

Folic acid group: 300

Control group: 293

High dose vitamin group: 1853

Low dose vitamin group: 1827

14 cohort studies

data from 2529 cases and 7305 non-cases

data from 30 studies

5073 IHD events

Sex

 

 

 

 

 

 

 

  % male

53

77

Intervention: 79

Placebo: 82

Intervention: 76

Control: 80

Low Dose:

62.8

High Dose:

62.3

 

 

  % female

47

23

Intervention: 21

Placebo: 18

Intervention: 24

Control: 20

Low Dose:

37.2

High Dose:

37.7

 

 

Mean BMI

quartile 1: 25.8 + 3.6

quartile 2: 25.3 + 3.8

quartile 3: 26.2 + 3.6

quartile 4: 26.1 + 4.1

CAD group: 25.7 +/- 2.7

Reference group: 24.8 +/- 3.7

 

Folic acid: 26.7 +/- 3.4

Control: 27.3 +/- 3.6

Low Dose:

28.1 +/- 5.3 men;

28.5 +/- 5.9 women

High Dose:

28.1 +/- 5.3 men;

28.7 +/- 6.7 women

 

 

Race

Hispanic vs non-white Hispanic

participants from Taiwan; ? Race for all

 

 

Low Dose:

  • black 15.4%,
  • white 78.4%,
  • other 6.2%

High Dose:

  • black 14.2%,
  • white 80.6%,
  • other 5.2%

 

 

Mean age (yrs)

Men:

quartile 1:73 +/- 5.3

quartile 2: 73 +/- 5.6

quartile 3: 74.6 +/- 6

quartile 4: 75 +/- 6.9

Women

quartile 1: 72.5 +/- 5.3

quartile 2: 73.4 +/- 5.7

quartile 3: 73.7 +/- 6.8

quartile 4: 75.8 +/- 6.5

CAD group: 71.6 +/- 9.7

Reference group: 65.5 +/- 9.0

Intervention: 63.4 +/- 10.6

Placebo: 61.8 +/- 11

Folic acid: 64.9 +/- 9.9

Control: 65.5 +/- 9.7

Low Dose:

66.2 +/- 10.8

High Dose:

66.4 +/- 10.8

 

 

Baseline Values

TC (mg/dL)

Men:

quartile 1: 198.9 + 41.2,

quartile 2: 199.2 + 33.5,

quartile 3: 199.9 + 42.8,

quartile 4: 189.1 + 46.7

Women:

quartile 1: 224.6 + 43.4,  quartile 2: 220.6 + 36.5, 

quartile 3: 214.3 + 39.3,

quartile 4: 219.8 + 42.0

CAD group: 201.8 +/- 40.2

Reference group: 173.4 +/- 36.6

Intervention: 214 +/- 43

Placebo: 212 +/- 46 placebo

Folic acid: 4.7 +/- 0.8 mmol/L

Control: 4.5 +/- 0.7 mmol/L

Low Dose: 203.0 +/- 46.5

High Dose: 200.8 +/- 46.9

 

 

LDL-C (mg/dL)

 

CAD group: 127.5 +/- 35.7

Reference group: 112 +/- 30.1

Intervention: 130 +/- 37

Placebo: 130 +/- 40 placebo

Folic acid: 2.7 +/- mmol/L

Control: 2.6 +/- 0.6 mmol/L

Low Dose: 123.3 +/- 40.1

High Dose: 121.6 +/- 40.2

 

 

TG (mg/dL)

 

CAD group: 138.2 +/- 76.9

Reference group: 87.2 +/- 43.9

Intervention: 181 +/- 113

Placebo: 178 +/- 113 placebo

Folic acid: 1.8 +/- 0.91 mmol/L

Control: 1.8 +/- 0.96 mmol/L

Low Dose: 172.7 +/- 108.7

High Dose: 176.8 +/- 190.1

 

 

HDL-C (mg/dL)

Men:

quartile 1: 44 + 13.6,

quartile 2: 43.2 + 12.1,

quartile 3: 42.1 + 10.8,

quartile 4: 44.7 + 16.8

Women:

quartile 1: 54.8 + 14.5,

quartile 2: 51.6 + 13.7,

quartile 3: 55.3 + 14.9,

quartile 4: 50.5 + 14

CAD group: 47.3 +/- 11.5

Reference group: 49.1 +/- 15.1

Intervention: 46 +/- 13

Placebo: 45 +/- 13 placebo

Folic acid: 1.12 +/- 0.33 mmol/L

Control: 1.14 +/- 0.30 mmol/L

Low Dose: 45.6 +/- 15.7

High Dose: 45.2 +/- 15.3

 

 

Homocysteine (umol/L)

     

     

     

     

Men:

quartile 1: 9.9 +/- 1.2

quartile 2: 12.2 +/- 0.5

quartile 3: 15.2 +/- 1.2

quartile 4: 23.2 +/- 11.3

Women:

quartile 1: 8.6 +/- 0.9

quartile 2: 10.8 +/- 0.7

quartile 3: 13.4 +/- 0.9

quartile 4: 19.1 +/- 6.6

CAD group: 13.9 +/- 4.9

Reference group: 9.1 +/- 3.3 (p<0.001)

Intervention: 11.4 +/- 4.73

Placebo: 11.1 +/- 4.59 placebo

Folic acid: 12.0 +/- 4.8 umol/L

Control: 12.2 +/- 3.8 umol/L

greater than 25th percentile for North American stroke population in both groups (8.5 for women and 9.5 for men) mean: 13.4 umol both groups

 

 

Results (% change)

not an intervention study

not an intervention study

 

 

 

 

 

TC

 

 

 

 

Low Dose: 194.0 +/- 40.8

High Dose: 193.8 +/- 42.5

 

 

TG

 

 

 

 

Low Dose: 173.5 +/- 107.0

High Dose: 170.3 +/- 101.6

 

 

HDL

 

 

 

 

Low Dose: 47.8 +/- 15.0

High Dose: 49.2 +/- 16.7

 

 

Plasma folic Acid

 

 

no data available

increase about 16 nmol/L in folic acid

33 +/- 6 nmol/L folic acid

no real data presented: graph shows that high dose had sig higher folate, but no real change in low dose

 

 

Plasma Homocysteine

 

 

decrease in homocystein:

6 month f/u: 7.5 +/- 2.51 intervention

10.1 +/- 4.22 in placebo

decrease 18% in folic acid group

9.4 +/- 3.5 umol/L folic acid

decrease was largest in high dose group about 2.0

decrease about 0.3 in low dose group

 

 

Other Outcome

Coronary events (% reduction) Association between Hcyt and prevalence of CAD

Sig findings only Continuous variable (per one unit in umol/L) women 3.52 (1.16-7.22) Hispanic women 4.61 (1.16-18.4)

Dichotomous variable (>/=15 vs <15 umol/L) women 2.99 (1.59-5.62)

Hispanic women 4.3 (1.74-10.6)

CAD group had significantly higher plasma Hcyt concentrations than reference

group

third cholesterol tertile in intervention group (> 228) had largest risk reduction in terms of target revascularization R = 0.44 (0.21-0.92) nonsignificant trend to decrease incident of nonfatal MI (RR=0.60 (0.24-1.51), p=0.22), cardiac deaths (RR=0.52 (0.13-2.04) p=0.34), and overall deaths (RR=0.54 (0.16-1.7), p=0.27) in intervention

treatment with folic acid did not result in lowering recurrence of cardiovascular events

no treatment effect between baseline Hcyt and CVD in follow up high dose vitamin group had no effect on the

outcome of stroke, CHD events, or death

increments in plasma Hcyt results in significant increase in risk for CVD  (ARR=1.33 (1.21-1.47), p=0.004) increase in coronary heart disease (ARR=1.49 (1.31-1.70, p=0.006)

25% lower usual Hcyt (~3umol/L) results in 11% lower IHD risk (OR=0.89 (0.83-0.96) and 19% lower stroke risk (OR=0.81 (0.69-0.95)