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By DrRich

Dateline: September 2, 2002

It has long been recognized that elevated levels of the amino acid homocysteine is a risk factor for heart attack, and after angioplasty or stenting, is a risk factor for restenosis.  Now a study published in the August 28 issue of the Journal of the American Medical Association shows that a 6-month regimen of vitamins aimed at reducing homocysteine levels significantly lowers the risk of restenosis after angioplasty and/or stenting.

In this study, 553 patients who had angioplasty and/or stenting were randomized to receive either placebo, or a combination of folic acid, vitamin B12, and vitamin B6 for 6 months after their procedure.  Patients were then followed for an additional 6 months (total of 1 year.)  At the end of 1 year, patients who received the vitamin combination experienced a significantly reduced incidence of "major adverse cardiac events" than patients who received placebo.  While "major adverse cardiac events" included such events as heart attack and death, the majority of the benefit resulted from a decrease in the risk of restenosis, and subsequently in the need for further coronary artery interventions.

The folic acid/B vitamin treatment was tolerated very well by patients in this study.

What does this mean if you are having angioplasty or stenting?

Restenosis is the major remaining problem with angioplasty and stenting in the treatment of coronary artery disease, but large strides are finally being made toward controlling this problem.  Using antiplatelet drugs to reduce restenosis has now become routine.  Statins also have been shown to reduce the incidence of "major adverse cardiac events" after coronary artery interventions, and ought to be given routinely in this circumstance.  Drug-coated stents - not yet available in the United States, but due sometime in 2003 - promise to be a major advance in the prevention of restenosis. Now add to this list the vitamin cocktail described in this new study.

Not all the pertinent questions have been answered about using vitamin therapy to reduce the incidence of restenosis.  Is the combination of vitamins used in this study the "best" combination?  Are the doses used optimal?  Would treating for longer than 6 months increase the benefit?  Should vitamins be used instead of statins, or should statins be used instead of vitamins, or should statins and vitamins be used together?

Studies are underway to address most of these questions.  In the meantime, because the folic acid/B vitamin combination is inexpensive and well-tolerated, doctors should strongly consider using these vitamins in patients having angioplasty and/or stenting - and patients having these procedures should make sure their doctors either prescribe these vitamins, or provide a very good explanation as to why they're not.


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