Decrease of carotid intima-media thickness in patients at risk to cerebral ischemia after supplementation with folic acid, Vitamins B6 and B12

Hyperhomocysteinemia is associated with atherosclerotic risk. Although vitamins can lower homocysteine (Hcy), information about effects on atherosclerosis is scarce. Methods: We used carotid intima-media thickness (IMT) as an accepted marker of atherosclerotic changes. Fifty patients (60 ± 8 years) with IMT ≥ 1 mm were included. In a double blind, randomized trial they received daily 2.5 mg folic acid, 25 mg Vitamin B6, and 0.5 mg Vitamin B12 or placebo for 1 year. Results: In the treatment group, Hcy decreased from 10.50 ± 3.93 to 6.56 ± 1.53 μmol/l (P < 0.0001), whereas it remained unchanged in the placebo group (10.76 ± 2.36 versus 10.45 ± 3.30 μmol/l). IMT decreased from 1.50 ± 0.44 to 1.42 ± 0.48 mm (P = 0.034) in the treatment group, whereas it increased from 1.47 ± 0.57 to 1.54 ± 0.71 mm in the placebo group. The mean individual changes of IMT between both groups differed significantly (−0.08 ± 0.17 versus 0.07 ± 0.25 mm, P = 0.019). Multiple regression analysis revealed that the observed effect on IMT depended only on medication. Conclusions: Vitamin supplementation significantly reduces IMT in patients at risk. This effect is independent of Hcy concentration.