Effect of Folic acid on Serum Homocysteine and Morbidity in Patients with Chronic Coronary Artery Disease

Background- In addition to traditional cardiovascular risk factors, high levels of plasma homocysteine has been documented recently as independent risk factors for atherosclerosis. The probable mechanism is through endothelial dysfunction. Roughly 10% of the population with coronary artery disease (CAD) may have hyper-homocysteinemia. Since folic acid is a potential factor in lowering plasma homocysteine and dietary intake of folic acid is not sufficient, it needs to be prescribed to CAD patients as a supplement. The purpose of this study is to assess the effect of folic acid on plasma homocysteine levels and on morbidity in stable CAD patients. Methods- In this prospective interventional study, we recruited 52 stable CAD patients; the plasma levels of homocysteine, folic acid and vitamin B12 were measured. The morbidity-related indices (the number of sublingual TNGs per week, typical anginal chest pain per week, the number of cardiovascular-related hospitalizations in the previous 3 months, functional class and ECG changes) were determined. All patients received 2 mg oral folic acid daily for 3 months. At the end of the study, the level of homocysteine and morbidity were determined.Results- Folic acid supplementation for 3 months was associated with a decrease in homocysteine level by 44% (P=0.000). We did not observe a significant change in levels of serum folic acid. There were significant declines in all morbidity indices including TNG consumption, frequency of chest pain, functional class and hospitalizations (P=0.001). Conclusion- The findings indicate that 2 mg folic acid orally daily for 3 months is associated with a decrease in homocysteine level and morbidity in CAD patients (Iranian Heart Journal 2007; 8 (2): 44-50).