Mashavi M, Hanah R, Boaz M, et al. Effect of homocysteine-lowering therapy on arterial elasticity and metabolic parameters in metformin-treated diabetic patients. Atherosclerosis 2008 Aug;199(2):362-367.
http://linkinghub.elsevier.com/retrieve/pii/S0021-9150(07)00764-2
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Atherosclerosis. 2008 Aug;199(2):362-7. Epub 2008 Jan 18.
Effect of homocysteine-lowering therapy on arterial elasticity and metabolic parameters in metformin-treated diabetic patients.
Mashavi M, Hanah R, Boaz M, Gavish D, Matas Z, Fux A, Shargorodsky M.
Department of Medicine, Wolfson Medical Center, Tel Aviv, Israel; Department of Diabetes, Wolfson Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Metformin may affect the risk of atherothrombotic disease. However, metformin increases levels of homocysteine (Hcy), considered an independent risk factor for atherosclerosis. We evaluate whether homocysteine-lowering has a beneficial effect on arterial elasticity and metabolic parameters in metformin-treated diabetic patients. In double-blind, placebo-controlled study, 60 diabetic patients treated with high dose of metformin were randomly assigned to receive daily oral supplementation with folate (1000mcg), vitamins B12 (400mcg) and B6 (10mg) (group 1) or placebo (group 2). Lipid profile, HbA1C, insulin, C-peptide, hs-CRP, vitamin B12, folic acid, homocysteine, endothelin, homeostasis model assessment-insulin resistance (HOMA-IR) were measured. Arterial elasticity was evaluated using pulse wave contour analysis (HDI CR 2000, Eagan, MN). The two groups were similar at baseline in terms of hemodynamic and arterial elasticity parameters. After a 4-month small artery elasticity index (SAEI) was significantly greater in patients who received Hcy-lowering agents than in the placebo group: 4.3+/-2.04ml/mmHgx100 versus 3.2+/-1.1ml/mmHgx100, p=0.01. Post-treatment vitamin B12 and folic acid levels were greater in group 1 versus group 2: 738.1+/-279.9pg/ml versus 566.1+/-167.4pg/ml, p=0.007 and 14.9+/-4.8ng/ml versus 8.3+/-2.9ng/ml, p
PMID: 18206891
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Folate and vitamins B6 and B12 administration may be associated with a decrease in homocysteine levels, which in turn may beneficially affect small arterial elasticity
remarks:
In a randomized, double-blind, placebo-controlled study involving 60 metformin-treated diabetic patients, results indicate that supplementation with folate and vitamins B6 and B12 may exert a beneficial effect on small arterial elasticity. The patients (receiving high dose metformin) were randomized to daily supplementation with 1000 mcg folate, 400 mcg vitamin B12, and 10 mg vitamin B6, or placebos. At 4-month end, small artery elasticity index was significantly greater in the folate and vitamins-supplemented group, compared with the placebo group. Additionally, homocysteine (Hcy) levels significantly decreased, and folic acid and vitamin B12 levels increased in the folate and vitamins-supplemented group. Thus, the authors of this study conclude, "Hcy-lowering therapy improved small arterial elasticity in diabetic patients treated with high dose of metformin. The improvement was associated with a decrease in Hcy as well as an increase in folic acid and vitamin B12. These findings suggest that Hcy-lowering may have beneficial vascular effect in metformin-treated diabetic patients."