scholarly journals Total Homocysteine Lowering Treatment Among Coronary Artery Disease Patients in the Era of Folic Acid Fortified Cereal Grain Flour

Circulation ◽  
2001 ◽  
Vol 103 (suppl_1) ◽  
pp. 1367-1367
Author(s):  
Andrew G Bostom ◽  
Gintaras Liaugaudas ◽  
Paul F Jacques ◽  
Irwin H Rosenberg ◽  
Jacob Selhub
Keyword(s):  
Coronary Artery Disease ◽  
Folic Acid ◽  
Coronary Artery ◽  
Geometric Mean ◽  
High Dose ◽  
Cereal Grain ◽  
Pre Treatment ◽  
Artery Disease ◽  
Stable Cad ◽  
B Vitamin

P86 Background: The prevalence of both deficient plasma folate status, and elevated total (t) plasma levels of the putatively atherothrombotic amino acid homocysteine (Hcy), have been dramatically reduced since the recent advent of fortification of all enriched cereal grain flour products with physiological amounts (i.e., 140 μg/ 100 g flour) of folic acid. Against this new background fortification, we evaluated the tHcy-lowering efficacy of pharmacological dose, folic acid based B-vitamin supplementation among stable coronary artery disease (CAD) patients. Methods and Results: Using a 2x2 factorial design, we randomly assigned 131 stable CAD patients (mean age 60.1 years; 29.8 % women) to folic acid 2.5 mg/d, riboflavin 5 mg/d, + B12 0.4 mg/d [ FA group] or FA placebo [PL] , ± B6 [ B6 group] 50 mg/d or B6 placebo[PL], for 12 weeks of treatment. All pre-treatment and final on-treatment analyte values were based on the average of two blood collections performed within 1-week. Geometric mean pre-treatment, on-treatment, and pre-treatment minus on-treatment change in (Δ) tHcy levels (μmol/L), were- FA, B6 (n=31): 8.7 (pre-), 7.4 (on-), Δ= -1.3; B6, PL (n=32): 8.7 (pre-), 9.1 (on-), Δ= + 0.4; FA, PL (n=34): 9.0 (pre-), 8.0 (on-), Δ= - 1.0; PL, PL (n=34): 8.4 (pre-), 8.5 (on-), Δ= + 0.1. ANCOVA adjusted for baseline tHcy levels revealed that the very modest (i.e., ∼ 1.0 μmol/L) reductions in fasting values afforded by the FA containing treatments were statistically significant (p <0.05). Conclusions: In the era of cereal grain flour products fortified with physiological amounts of folic acid, stable CAD patients supplemented with high dose, folic acid containing B-vitamin regimens experience only very modest reductions in their mean plasma tHcy levels. These findings have important implications for the statistical power of clinical trials testing the hypothesis that tHcy-lowering treatment may reduce recurrent atherothrombotic event rates.

Lack of association between plasma homocysteine and angiographic coronary artery disease in the era of fortification of cereal grain flour with folic acid

2002 ◽  
Vol 165 (2) ◽  
pp. 375-381 ◽  
Author(s):  
Emmanouil S Brilakis ◽  
Joseph P McConnell ◽  
Karla V Ballman ◽  
George G Klee ◽  
Peter B Berger
Keyword(s):  
Coronary Artery Disease ◽  
Folic Acid ◽  
Coronary Artery ◽  
Plasma Homocysteine ◽  
Cereal Grain ◽  
Artery Disease

scholarly journals Total Homocysteine Lowering Treatment Among Coronary Artery Disease Patients in the Era of Folic Acid-Fortified Cereal Grain Flour

2002 ◽  
Vol 22 (3) ◽  
pp. 488-491 ◽  
Author(s):  
Andrew G. Bostom ◽  
Paul F. Jacques ◽  
Gintaras Liaugaudas ◽  
Gail Rogers ◽  
Irwin H. Rosenberg ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Folic Acid ◽  
Coronary Artery ◽  
Cereal Grain ◽  
Total Homocysteine ◽  
Artery Disease ◽  
Fortified Cereal

Prevalence of mild fasting hyperhomocysteinemia in renal transplant versus coronary artery disease patients after fortification of cereal grain flour with folic acid

1999 ◽  
Vol 145 (1) ◽  
pp. 221-224 ◽  
Author(s):  
Andrew G. Bostom ◽  
Reginald Y. Gohh ◽  
Gintaras Liaugaudas ◽  
Andrew J. Beaulieu ◽  
Haewook Han ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Folic Acid ◽  
Coronary Artery ◽  
Renal Transplant ◽  
Cereal Grain ◽  
Artery Disease

scholarly journals High-Dose Folic Acid Acutely Improves Coronary Vasodilator Function in Patients With Coronary Artery Disease

2005 ◽  
Vol 45 (10) ◽  
pp. 1580-1584 ◽  
Author(s):  
Ahmed Tawakol ◽  
Raymond Q. Migrino ◽  
Kusai S. Aziz ◽  
Justyna Waitkowska ◽  
Gotfred Holmvang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Folic Acid ◽  
Coronary Artery ◽  
High Dose ◽  
Coronary Vasodilator ◽  
Artery Disease

The Effect of Antiplatelet Drugs on Plasma Betathromboglobulin in Coronary Artery Disease

1979 ◽  
Author(s):  
P Han ◽  
A Turpie ◽  
E Genton ◽  
M Gent
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Crossover Trial ◽  
Specific Protein ◽  
Antiplatelet Drugs ◽  
Significant Difference ◽  
Pre Treatment ◽  
Artery Disease ◽  
Therapeutic Doses ◽  
Granule Release

Platelets play a role in the development and complications of coronary artery disease (CAD) and a number of abnormalities of platelet function which can be corrected by antiplatelet drugs have been described. Betathromboglobulin (BTG), a platelet-specific protein which is released from α-granules during platelet activation is significantly elevated in patients with angiographically demonstrated CAD (51.0 ± 31.0 ng/ml., n = 50) compared to normal (28.0 ± 8.0 ng/ml., n = 70) p < 0.001. The effect of sulphinpyrazone (800 mg.) or aspirin (1200 mg.)/dipyridamole (200 mg.) on plasma BTG in CAD was studied in a blind prospective crossover trial in 25 patients. Mean BTG concentration pre-treatment was 52.3 ng/ml. and after 1 month’s treatment with placebo, sulphinpyrazone or aspirin/dipyridamole mean plasma BTG concentrations were 53.5, 49.6 and 56.7 ng/ml. respectively. Analysis of variance showed no significant difference between the means (p > 0.1) . This study confirms increased plasma BTG concentrations in patients with CAD and indicates that therapeutic doses of these antiplatelet drugs do not significantly effect the BTG level and thus appear not to prevent α-granule release in CAD.

Osteoprotegerin and Osteopontin Serum Levels are Associated with Vascular Function and Inflammation in Coronary Artery Disease Patients

2020 ◽  
Vol 18 (5) ◽  
pp. 523-530 ◽  
Author(s):  
Konstantinos Maniatis ◽  
Gerasimos Siasos ◽  
Evangelos Oikonomou ◽  
Manolis Vavuranakis ◽  
Marina Zaromytidou ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Endothelial Function ◽  
Vascular Function ◽  
Serum Levels ◽  
Atherosclerosis Progression ◽  
Control Subjects ◽  
Significant Difference ◽  
Artery Disease ◽  
Stable Cad

Background: Osteoprotegerin and osteopontin have recently emerged as key factors in both vascular remodelling and atherosclerosis progression. Interleukin-6 (IL-6) is an inflammatory cytokine with a key role in atherosclerosis. The relationship of osteoprotegerin, osteopontin, and IL-6 serum levels with endothelial function and arterial stiffness was evaluated in patients with coronary artery disease (CAD). Methods: We enrolled 219 patients with stable CAD and 112 control subjects. Osteoprotegerin, osteopontin and IL-6 serum levels were measured using an ELISA assay. Endothelial function was evaluated by flow-mediated dilation (FMD) in the brachial artery and carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness. Results: There was no significant difference between control subjects and CAD patients according to age and sex. Compared with control subjects, CAD patients had significantly impaired FMD (p<0.001) and increased PWV (p=0.009). CAD patients also had significantly higher levels of osteoprotegerin (p<0.001), osteopontin (p<0.001) and IL-6 (p=0.03), compared with control subjects. Moreover, IL-6 levels were correlated with osteoprotegerin (r=0.17, p=0.01) and osteopontin (r=0.30, p<0.001) levels. FMD was correlated with osteoprotegerin levels independent of possible confounders [b coefficient= - 0.79, 95% CI (-1.54, -0.05), p=0.04]. Conclusion: CAD patients have increased osteoprotegerin, osteopontin and IL-6 levels. Moreover, there is a consistent association between osteoprotegerin and osteopontin serum levels, vascular function and inflammation in CAD patients. These findings suggest another possible mechanism linking osteoprotegerin and osteopontin serum levels with CAD progression through arterial wall stiffening and inflammation.

High-dose statin therapy and the risk of haemorrhagic stroke in Asian patients with stable coronary artery disease: insights from the REAL-CAD study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Takahashi ◽  
K Tsuchida ◽  
Y Sato ◽  
S Iimuro ◽  
K Kario ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Dose Group ◽  
Low Dose ◽  
Japanese Patients ◽  
Haemorrhagic Stroke ◽  
High Dose ◽  
The Real ◽  
Artery Disease ◽  
Stable Cad ◽  
Bleeding Score

Abstract Background/Introduction The REAL-CAD study identified that aggressive lipid lowering with high-dose statin reduced cardiovascular events also in Japanese patients with coronary artery disease (CAD). However, data from the SPARCL trial found that the benefits of high-dose atorvastatin treatment were partially offset by an increase in haemorrhagic stroke (HS). Although meta-analysis showed statin does not increase HS in Western countries, the evidence about the relation between statin and HS in Asian countries is still conflicting. In addition, the CREDO-Kyoto score is one of the prediction scorings for bleeding after coronary revascularization and might be a useful tool for the prediction of HS in this cohort. Recognizing the risk of HS and predicting of HS in the Asian cohort is clinically important. Purpose This study examined the factors associated with HS using the REAL-CAD cohort. Furthermore, we evaluated the performance of the CREDO-Kyoto bleeding risk score to predict HS in this cohort. We also performed the corresponding analysis of ischaemic stroke for reference purposes. Methods We sub-analysed the REAL-CAD study, prospective, multicentre, randomized, open-label, blinded endpoint study, in which 13,054 Japanese patients with stable CAD were randomized to high-dose (4 mg/day) or low-dose (1 mg/day) pitavastatin. Associations for stroke were determined using competing risk models: the Fine and Gray subdistribution hazards model accounting for the competing risk of death in models of haemorrhagic and ischaemic stroke in REAL-CAD trial. Patients were categorized to low (score 0), moderate (score 1–2), and high (score&gt;3) according to CREDO-Kyoto bleeding score for predicting of HS. Results The HS events in high-dose group tended to be higher than low-dose group (4mg vs. 1mg: 43 (0.7%) vs. 30 (0.5%)). The associated factors of HS on univariate analysis were non-prior myocardial (hazard ratio (HR): 0.62, 95% CI: 0.39–0.99) and non-prior cerebral (HR: 0.25, 95% CI: 0.09–0.70) infarction, atrial fibrillation (HR: 2.4, 95% CI: 1.2–4.7), prior HS (HR: 4.2, 95% CI: 1.5–11.8), anaemia (HR: 2.4, 95% CI: 1.4–4.1), and non-statins use before run-in period (HR: 0.52, 95% CI: 0.28–0.99). High-dose pitavastatin was not a correlate with HS. The multivariate analysis revealed anaemia might have a relation with HS (HR: 4.3, 95% CI: 0.90–20.6). The number of HS was the highest in the high CREDO-Kyoto bleeding score group (Figure 1, HR: 2.4, 95% CI: 1.3–4.6), whereas there was no significant difference in the number of HS between the moderate- and low-risk groups (HR: 1.4, 95% CI: 0.84–2.3). Conclusions High-dose pitavastatin was not associated with the incidence of HS in this large Japanese cohort with stable CAD. High CREDO-Kyoto bleeding score was associated with HS as compared with low or moderate scores, even each of the variables consisting of CREDO-Kyoto score was not associated with HS. Figure 1 Funding Acknowledgement Type of funding source: None

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