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Folic Acid-Based Intervention in Non-ST Elevation Acute Coronary Syndromes

¹ Department of Pharmacology, University of the Philippines College of Medicine, Manila
² Philippine Heart Center, Quezon City
³ Department of Biochemistry and Molecular Biology, University of the Philippines College of Medicine, Manila

Jose B Nevado, Jr, MD, Tel: +240 301 482 9625, Fax: +(632) 526 4197 301 451 7090, Email: jolnev2000{at}yahoo.com, 547 Pedro Gil Street, Ermita, Manila, Philippines.

ABSTRACT

Homocysteinemia is a risk factor for cardiovascular diseases. Folic acid combined with vitamins B₆ and B₁₂ is effective in lowering homocysteine levels. This randomized placebo-controlled study was designed to determine the effect of a folic acid-based supplement on secondary prevention of clinical events in non-ST-segment elevation acute coronary syndromes. The study comprised 240 patients with either unstable angina or non-ST-elevation myocardial infarction in the previous 2 weeks who were randomized to a folate group (n =116) or a placebo group (n =124). The folate group received 1 mg folic acid, 400 µg vitamin B₁₂, and 10 mg vitamin B₆ daily. Clinical outcomes within 6 months were assessed. The composite endpoint of death, nonfatal acute coronary syndrome, and serious re-hospitalization was significantly higher in the folate group; serious re-hospitalization alone was significantly higher in this group. Advanced age and diabetes increased susceptibility to the composite outcome. Folic acid-based supplementation is not beneficial and may even be harmful in the secondary prevention of cardiovascular events in patients with unstable angina and non-ST-elevation myocardial infarction. Further studies on the safety of such supplements are suggested. Controlled Clinical Trials Registry no. ISRCTN30249553.

Key Words: Unstable angina • Angina • Unstable • Folic Acid • Homocysteine • Myocardial Infraction • Randomized Controlled Trial

Asian Cardiovasc Thorac Ann 2009; 17:13-21
© 2009 by SAGE Publications
DOI: 10.1177/0218492309102494

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