The effect of different treatment regimens in reducing fasting and postmethionine‐load homocysteine concentrations

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Abstract
Van der Griend R, Biesma DH, Haas FJLM, Faber JAJ, Duran M, Meuwissen OJATh, Banga J‐D (Sint Antonius Hospital, Nieuwegein; University of Utrecht, Utrecht; and the University Medical Center Utrecht, The Netherlands). The effect of different treatment regimens in reducing fasting and post‐methionine‐load homocysteine concentrations. J Intern Med 2000; 248: 223–229. Objectives. To determine the homocysteine‐lowering effect of different treatment regimens on both fasting and postmethionine‐load plasma total homocysteine (tHcy) concentrations. Design. Descriptive study of consecutive hyperhomocysteinaemic subjects per treatment regimen. Homocysteine was measured in the fasting state and 6 h after methionine loading, both before and after 8 weeks of vitamin therapy. Hyperhomocysteinaemia was defined as a fasting tHcy and/or increase in tHcy (postmethionine‐load minus fasting tHcy concentration) exceeding the 95th percentile of local controls. Setting. Outpatient clinic of internal medicine of a large non‐academic teaching hospital. Subjects. One hundred and seventeen hyperhomocysteinaemic subjects (vascular patients and first‐degree relatives). Interventions. There were four regimens: pyridoxine, 200 mg; folic acid, 5 mg; combination of folic acid 0.5 mg and pyridoxine 100 mg; and folic acid, 0.5 mg daily. Results. All regimens, except pyridoxine 200 mg, significantly reduced fasting tHcy without differences in the percentage reduction (32–38%). All regimens produced a significant reduction in the increase in tHcy and postmethionine‐load tHcy. The reduction in postmethionine‐load tHcy was smaller for pyridoxine 200 mg than for combination therapy. No differences were found in the percentage reduction (for both increase in tHcy and postmethionine‐load tHcy) between folic acid 5 mg and folic acid 0.5 mg. Conclusions. Monotherapy folic acid (0.5 mg daily) is the lowest effective therapy for reducing both fasting and postmethionine‐load tHcy concentrations, with the same results as high‐dose folic acid (5 mg daily). Pyridoxine has no additional value.