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

ABSTRACT

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