• Am. J. Clin. Nutr. · Sep 2004

    Randomized Controlled Trial Clinical Trial

    Changes in basal and postmethionine load concentrations of total homocysteine and cystathionine after B vitamin intervention.

    • Øyvind Bleie, Helga Refsum, Per Magne Ueland, Stein Emil Vollset, Anne Berit Guttormsen, Ebba Nexo, Jørn Schneede, Jan Erik Nordrehaug, and Ottar Nygård.
    • Institute of Medicine, University of Bergen, Haukeland University Hospital, N-5021 Bergen, Norway. oyvind.bleie@haukeland.no
    • Am. J. Clin. Nutr. 2004 Sep 1;80(3):641-8.

    BackgroundVitamin B-6 is necessary for the metabolism of homocysteine and is often used in combination with folic acid and vitamin B-12 in clinical trials that investigate whether the lowering of plasma total homocysteine (tHcy) can prevent vascular disease.ObjectiveWe compared the effects of vitamin B-6 with the effects of folic acid and vitamin B-12, as used in the Western Norway B-vitamin Intervention Trial (WENBIT), on basal and postmethionine load (PML) tHcy and cystathionine concentrations.DesignNinety patients with suspected coronary artery disease were randomly assigned to 1 of 4 groups to receive daily oral treatment with 1) 0.8 mg folic acid, 0.4 mg vitamin B-12, and 40 mg vitamin B-6 (group A); 2) 0.8 mg folic acid and 0.4 mg vitamin B-12 (group B); 3) 40 mg vitamin B-6 (group C); or 4) placebo (group D). For the first 2 wk, groups A and B received additional folic acid (5 mg/d). A methionine-loading test was performed at baseline and after 3 mo.ResultsTreatment with folic acid and vitamin B-12 caused a rapid and significant lowering of basal (31%) and PML tHcy concentrations (22%), with no effect on cystathionine. Vitamin B-6 did not change basal tHcy and had a significant but limited effect on PML tHcy concentrations. However, vitamin B-6 treatment markedly lowered basal and PML cystathionine by 31% and 42%, respectively.ConclusionThe folic acid and vitamin B-12 combination applied in WENBIT provides rapid, substantial, and long-term tHcy-lowering effects, whereas the effect of vitamin B-6 on tHcy was relatively small and confined to PML tHcy. However, vitamin B-6 treatment caused a marked reduction in plasma cystathionine. Cystathionine could be a useful marker for assessment of the vitamin B-6 effect and should, together with tHcy, be related to clinical outcome in ongoing trials.

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