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Effect of homocysteine-lowering therapy on vascular endothelial function and exercise performance in coronary

Mustafa Hakan Dinckal1, Nur Aksoy, Mehmet Aksoy

  • 1Department of Cardiology, Medical Faculty of Gaziantep University, Gaziantep, Turkey. mhdinckal@gantep.edu.tr

Acta Cardiologica
|November 12, 2003
PubMed

Insights

Homocysteine-lowering therapy (HLT) significantly improved endothelium-dependent vasodilation and exercise performance in coronary artery disease patients. This intervention also reduced exercise-induced myocardial ischemia, indicating potential benefits for cardiovascular health.

Area of Science:

  • Cardiovascular Medicine
  • Clinical Nutrition
  • Vascular Biology

Background:

  • Elevated homocysteine (Hcy) levels are linked to endothelial dysfunction and cardiovascular disease.
  • Coronary artery disease (CAD) patients often exhibit hyperhomocysteinemia, impacting vascular health.
  • Endothelium-dependent vasodilation (EDD) is a key indicator of vascular function and cardiovascular risk.

Purpose of the Study:

  • To investigate the impact of homocysteine-lowering therapy (HLT) on EDD in patients with CAD.
  • To assess the effect of HLT on exercise performance in individuals with coronary artery disease.
  • To determine if HLT can mitigate exercise-induced myocardial ischemia in this patient population.

Main Methods:

  • A randomized controlled trial involving 26 male patients with CAD and elevated Hcy (>15 micromol/l).
  • Intervention group received HLT (folic acid, vitamin B6, vitamin B12) for approximately 3.8 weeks; placebo group received no active treatment.
  • Vascular function assessed via brachial artery vasomotion testing and exercise capacity via treadmill stress testing at baseline and after 4 weeks.

Main Results:

  • HLT significantly reduced plasma Hcy levels (23.4 to 11.3 micromol/l; p < 0.001), while placebo had no effect.
  • HLT markedly improved EDD (3.9% to 9.4%; p < 0.0001), with no change in endothelium-independent vasodilation.
  • Exercise testing showed improved exercise duration (6.5 to 6.9 min; p = 0.02) and reduced maximal ST-segment depression (1.2 to 0.8 mm; p = 0.01) in the HLT group.

Conclusions:

  • Lowering homocysteine levels through HLT effectively improves endothelial function in CAD patients.
  • HLT enhances exercise performance and reduces myocardial ischemia during exertion in individuals with hyperhomocysteinemia.
  • These findings suggest HLT is a promising therapeutic strategy for improving cardiovascular outcomes in patients with CAD and elevated Hcy.
Abstract

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