Effect of folic acid supplementation on plasma homocysteine levels in patients with coronary artery disease

Our objective was to asses the effect of folic acid supplementation on homocysteine levels in patients with established coronary artery disease. This quasi experimental study was carried out at department of Cardiology, KRL Hospital, Islamabad during the period of May 2002 to December 2003. The patients with raised fasting homocysteine levels were supplemented with 5mg of folic acid and were followed up for a period of six months. The primary end point was the change in homocysteine level and secondary end point was untoward cardiac events. In primary end point, folic acid supplementations decreased mean plasma homocysteine concentration in 17 [56.7%] of the patients with mean change in homocysteine concentration of up to 7.7 +/- 9.3 micro mol/l. There was evidence of substantial interindividual variation in the homocysteine response including an increase in homocysteine in 13 [43.3%] subjects [mean increase 5.5 +/- 10.7 pmol/l]. In secondary end point, three patients were admitted with exacerbation of chronic stable angina; they were ruled out for any myocardial damage. Twenty seven patients had uneventful follow up. The variability of response to folic acid replacement with paradoxical rise in homocysteine levels in certain individuals mandate that we retest the homocysteine level in patients undergoing folic acid replacement to establish its continued salutary response

Homocysteine status in coronary artery disease

Hyperhomocysteinemia is emerging as a prevalent and an independent risk factor for coronary artery disease. There is little known of this emerging risk factor in our own population. The aim of this descriptive study was to have preliminary assessment on the frequency of hyperhomocysteinemia in patients with coronary artery disease. This study was conducted at department of Cardiology, KRL Hospital, Islamabad from May 2002-June 2003. By using florescence polarization immunoassay, fasting homocysteine levels were measured in 50 patients with documented coronary artery disease. Out of these 50 patients, the baseline homocysteine levels were high in 68 percent [34/50] patients [15 umol/L taken as the cut-off value]. The mean homocystenine value was 20.35 umul/L with SD =10.28 umil /l. The average age at the time of diagnosis was 44 years [MY = 49:1]. There is an urgent need for large scale analytical studies to establish the exact role of homocysteine as a risk factor for cardiovascular disease in our population. The findings will have major implications as homocysteine is a potentially modifiable risk factor with little economic burden