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High-dose B vitamin supplementation and progression of subclinical atherosclerosis: a randomized controlled trial

Howard N Hodis1, Wendy J Mack, Laurie Dustin

  • 1Atherosclerosis Research Unit, Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, Calif. 90033, USA. athero@usc.edu

Stroke
|January 2, 2009
PubMed

Insights

High-dose B vitamin supplementation reduced early-stage atherosclerosis progression in individuals with elevated homocysteine levels. This finding suggests a potential therapeutic role for B vitamins in managing subclinical vascular disease.

Area of Science:

  • Cardiovascular Medicine
  • Nutritional Science
  • Clinical Trials

Background:

  • Elevated plasma total homocysteine (tHcy) is linked to cardiovascular disease, but its causal role in atherosclerosis is debated.
  • Understanding whether homocysteine is a cause or marker is crucial for effective cardiovascular disease prevention strategies.

Purpose of the Study:

  • To investigate if reducing tHcy levels through B vitamin supplementation can slow the progression of subclinical atherosclerosis.
  • To assess the impact of B vitamins on carotid artery intima-media thickness and arterial calcification.

Main Methods:

  • A double-blind clinical trial involving 506 participants (aged 40-89) with elevated tHcy (>8.5 micromol/L) and no diabetes or prior cardiovascular disease.
  • Participants received high-dose B vitamin supplementation (folic acid, B12, B6) or placebo for 3.1 years.
  • Subclinical atherosclerosis was measured using carotid artery intima-media thickness (ultrasonography) and aortic/coronary artery calcium scoring (CT).

Main Results:

  • B vitamin supplementation did not significantly reduce overall carotid artery intima-media thickness progression (P=0.31).
  • However, in participants with baseline tHcy ≥9.1 micromol/L, B vitamin supplementation significantly slowed carotid artery intima-media thickness progression (P=0.02).
  • No significant effect of B vitamin supplementation was observed on aortic or coronary artery calcification progression.

Conclusions:

  • High-dose B vitamin supplementation effectively reduces the progression of early-stage subclinical atherosclerosis, specifically carotid artery intima-media thickness.
  • This benefit was observed in well-nourished, B vitamin-replete individuals at low cardiovascular risk who had a fasting tHcy ≥9.1 micromol/L.
  • The findings suggest a potential role for B vitamins in mitigating atherosclerosis in specific at-risk populations.
Abstract

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