vitamin-b-12 and Acute-Coronary-Syndrome

High plasma homocysteine (Hcy) levels are known to be associated with coronary artery disease, but the precise level associated with an increased risk is yet controversial. Whether the beneficial effects of folic acid on arterial endothelial function persist over longer periods is not known. This study was carried out to assess whether folic acid supplementation could produce improvements in Hcy levels and arterial endothelial function in the patients with unstable angina (UA) and hyperhomocysteinaemia.. The plasma Hcy levels of 52 cases with UA and 30 control subjects were measured by using high-performance liquid chromatography (HPLC) with fluorescence detection, plasma folic acid and vitamin B(12) levels were also measured. The patients with hyperhomocysteinaemia were treated with 5 mg of folic acid for 8 wk, and then rechecked the plasma levels of Hcy, folic acid and vitamin B(12) at the end of 4(th) and 8(th) wk. Arterial endothelial function was measured as flow-mediated dilation of the brachial artery using high-resolution B-mode ultrasound in 22 cases with UA and hyperhomocysteinaemia before and after folic acid treatment.. The plasma Hcy level was significant higher in the patients with UA than in the controls (19.2 +/- 4.9 vs 10.7 +/- 5.3 micromol/l, P<0.01). The plasma levels of folic acid and vitamin B12 were significant lower in the patients with UA than in the controls. There were 22(42.3%) patients with hyperhomocysteinaemia in UA group. After 4 and 8 wk of administration of folic acid, the Hcy level reduced by 20.3 and 55.3 per cent in the UA patients with hyperhomocysteinaemia, respectively. Flow-mediated dilation also improved significantly, from 6.4 +/- 1.9 to 9.0 +/- 1.2 per cent (P<0.05) after 8 wk treatment with folic acid.. Plasma Hcy level was elevated in patients with UA. Folic acid can reduce the plasma Hcy levels and improve arterial endothelial function in the UA patients with hyperhomocysteinaemia.

Topics: Acute Coronary Syndrome; Adult; Aged; Angina, Unstable; Endothelium, Vascular; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Male; Middle Aged; Risk Factors; Vasodilation; Vitamin B 12; Vitamin B Complex

Vitamin B12 deficiency is not an independent risk factor for cardiovascular disease. However, anemia due to vitamin B12 deficiency and also hyperhomocysteinemia are among the cardiovascular risk factors. The study aimed to determine the frequency of vitamin B12 deficiency in patients with acute coronary syndrome. We also aimed to ascertain whether there is a significant difference between obstructive coronary artery disease presence and its severity in patients with and without vitamin B12 deficiency using the Gensini score.. Patients who underwent coronary angiography due to acute coronary syndrome between June 1, 2018, and November 30, 2019, and whose vitamin B12 levels were measured were retrospectively analyzed. Coronary angiography results of the patients were evaluated with the Gensini scoring system.. Anemia was observed in 32.6% (n = 135) of the patients who underwent coronary angiography with a diagnosis of acute coronary syndrome, and vitamin B12 deficiency was observed in 14.7% (n = 61). The median age was 69 years in anemic patients and 68 years in those with Vitamin B12 deficiency and was significantly higher than patients without anemia and vitamin B12 deficiency (p < 0.001 and p = 0.038, respectively). There was no statistically significant differences between the patients' Gensini scores with or without Vitamin B12 deficiency (p = 0.554).. We concluded that anemia and vitamin B12 deficiency were higher in elderly patients with acute coronary syndrome. We found no significant difference when the Gensini score was used to evaluate obstructive coronary artery disease presence and its severity according to anemia and vitamin B12 deficiency. Investigating vitamin B12 levels in elderly patients with acute coronary syndrome should not be ignored.

Topics: Acute Coronary Syndrome; Aged; Anemia; Humans; Hyperhomocysteinemia; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

The methylene-tetrahydrofolate dehydrogenase (NADP+ dependent) 1-like (MTHFD1L) gene is involved in mitochondrial tetrahydrofolate metabolism. Polymorphisms in MTHFD1L, including rs6922269, have been implicated in risk for coronary artery disease (CAD). We investigated the association between rs6922269 and known metabolic risk factors and survival in two independent cohorts of coronary heart disease patients.. DNA and plasma from 1940 patients with acute coronary syndromes were collected a median of 32 days after index hospital admission (Coronary Disease Cohort Study, CDCS). Samples from a validation cohort of 842 patients post-myocardial infarction (PMI) were taken 24-96 hours after hospitalization. DNA samples were genotyped for rs6922269, using a TaqMan assay. Homocysteine and active vitamin B12 were measured by immunoassay in baseline CDCS plasma samples, but not PMI plasma. All cause mortality was documented over follow-up of 4.1 (CDCS) and 8.8 (PMI) years, respectively. rs6922269 genotype frequencies were AA n = 135, 7.0%; GA n = 785, 40.5% and GG n = 1020, 52.5% in the CDCS and similar in the PMI cohort. CDCS patients with AA genotype for rs6922269 had lower levels of co-variate adjusted baseline plasma active vitamin B12 (p = 0.017) and poorer survival than patients with GG or GA genotype (mortality: AA 19.6%, GA 12.0%, GG 11.6%; p = 0.007). In multivariate analysis, rs6922269 genotype predicted survival, independent of established covariate predictors (p = 0.03). However the association between genotype and survival was not validated in the PMI cohort.. MTHFD1L rs6922269 genotype is associated with active vitamin B12 levels at baseline and may be a marker of prognostic risk in patients with established coronary heart disease.

Topics: Acute Coronary Syndrome; Alleles; Aminohydrolases; Biomarkers; Cohort Studies; Follow-Up Studies; Formate-Tetrahydrofolate Ligase; Genetic Association Studies; Genotype; Humans; Methylenetetrahydrofolate Dehydrogenase (NADP); Multienzyme Complexes; Myocardial Infarction; Polymorphism, Genetic; Prognosis; Survival Analysis; Time Factors; Vitamin B 12

To determine the occurrence of association between homocysteine, folate, or vitamin B12 plasma levels and acute coronary syndrome in Colombian patients.. Case control study: cases were 50 patients with acute coronary syndrome and controls were 50 outpatients without coronary syndrome. Homocysteine, folate and vitamin B12 levels were determined by means of chemiluminescence immunoassay. Cholesterol and lipoproteins, triglycerides, BUN, creatinine, hemoglobin and hematocrit were also measured.. Mean homocysteine plasma concentrations were significantly different between cases (12.4 micromol/l +/- 6.0) and controls (9.7 micromol/l +/- 2.4), p=0.01. The folic acid levels of the cases were lower than those of the control patients (10.5 ng/ml +/- 3.5 vs 12.6 ng/ml +/- 3.6, respectively, p=0.01). An inverse relationship was found between folate and homocysteine levels. No relationship was observed between vitamin B12 levels and homocysteine levels. There was a significant difference in triglyceride levels between case and control groups (136.91 +/- 67.27 vs 174.3 +/- 77.6, respectively, p=0.01). The odds ratio for hyperhomocysteinemia in acute coronary syndrome was 4.45 (95% confidence interval: 1.5 - 13.3).. The present study found a significant association between homocysteine levels and acute coronary syndrome in Colombian patients, similarly to the European and North American populations. There was a negative correlation between homocysteine plasma levels and folate levels. No association between plasmatic levels of homocysteine and those of vitamin B12 was observed.

Topics: Acute Coronary Syndrome; Adult; Biomarkers; Colombia; Epidemiologic Methods; Female; Folic Acid; Homocysteine; Humans; Lipids; Male; Middle Aged; Vitamin B 12