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HOMOCYSTEINE-LOWERING THERAPY AND LONG-TERM PROGNOSIS AFTER ELECTIVE PERCUTANEOUS CORONARY INTERVENTION

https://doi.org/10.20996/1819-6446-2011-7-5-7-12

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Abstract

Background. Vitamins В6 В12 and folic acid (FA) therapy to reduce cardiovascular risk appears to be unreasonable. Negative results of recent large-scale trials might be due to high daily doses of the vitamins and widespread FA fortification programmes. Russian population is known to have high prevalence of FA and vitamin B12 deficiency. Aim. To evaluate the effect of FA, B6 and B12 vitamins (in doses approximate to daily maintenance) on long-term prognosis after elective percutaneous coronary intervention (PCI) in stable ischemic heart disease patients. Material and methods. 264 patients (213 male, age 58.8±1.0 years) after successful PCI were involved into the trial. Patients with clinical signs of the vitamins deficiency were not included. Patients were randomly assigned to receive combination of FA (0.6 mg/day), B12 (10 μg/day), and B6 (4 mg/day) vitamins along with the conventional therapy (n=97) or the conventional therapy only (n=167) for 20 months. The groups were comparable in age, gender and prevalence of coronary risk factors. Composite endpoint was defined as cardiovascular death, acute coronary syndrome, stroke or transient is- chemic attack and need for coronary/carotid revascularization. Results. The vitamins prescription to all of the patients did not reduce composite endpoint incidence according to multivariable regression analysis (RR 0,7; 95%CI 0,4-1,4; p=0,3). Subgroup analysis showed significantly lower composite endpoint incidence in patients who received vitamins and had initially low B12 blood level (<260 pg/ml) as compared to the control group (RR 0.09; 95%CI 0.01-0.9; p=0.04). Conclusion. Treatment with FA, B and B vitamins improves prognosis after PCI in patients with initially low blood vitamin B level.

About the Authors

O. O. Shakhmatova
Russian Cardiology Research and Production Complex
Russian Federation


A. L. Komarov
Russian Cardiology Research and Production Complex
Russian Federation


A. N. Samko
Russian Cardiology Research and Production Complex
Russian Federation


T. I. Kotkina
Russian Cardiology Research and Production Complex
Russian Federation


D. V. Rebrikov
”DNA-Technology” Research and Production Company General Genetics Institute named after N.I. Vavilov
Russian Federation


A. D. Deev
State Research Center for Preventive Medicine
Russian Federation


E. P. Panchenko
Russian Cardiology Research and Production Complex
Russian Federation


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For citation:


Shakhmatova O.O., Komarov A.L., Samko A.N., Kotkina T.I., Rebrikov D.V., Deev A.D., Panchenko E.P. HOMOCYSTEINE-LOWERING THERAPY AND LONG-TERM PROGNOSIS AFTER ELECTIVE PERCUTANEOUS CORONARY INTERVENTION. Rational Pharmacotherapy in Cardiology. 2011;7(5):524-535. (In Russ.) https://doi.org/10.20996/1819-6446-2011-7-5-7-12

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)