Folic acid supplementation (FAS) can significantly reduce homocysteine levels and may therefore offer an approach for lowering cardiovascular (CV) risk among patients with Type 2 diabetes, report researchers.
"FAS may have a potential role, especially as primary prevention, in decreasing CV events in Type 2 diabetic patients," say Surasak Saokaew (University of Phayao, Thailand) and colleagues.
Total homocysteine (tHcy) level has previously been reported to be associated with CV risk and mortality in diabetic patients and has also been linked to risk for microalbuminuria, cognitive deterioration, diabetic neuropathy, and foot ulceration, explain Saokaew and team. It is thought to mediate its vasculotoxic effects by impairment of endothelial regulatory functions.
Writing in Diabetes Research and Clinical Practice, the team says that FAS lowers tHcy and may improve endothelial function in patients with coronary artery disease. However, evidence for the effects of FAS on tHcy in individuals with Type 2 diabetes has been contradictory.
In a meta-analysis of four studies with follow-up periods ranging from 4 weeks to 6 months, the team found that hyperhomocysteinemia was associated with a 1.9-fold increased mortality risk in patients with diabetes.
However, two random-effects models showed that FAS lowered the mean tHcy level among diabetic patients by 3.52 µmol/L more than placebo did, reports the team.
Furthermore, the mean glycated hemoglobin level decreased by 0.37 µmol/L more in the diabetic patients who took FAS than in those who took placebo, although this difference did not reach statistical significance.
The researchers remark that a previous meta-analysis showed that lowering tHcy levels by 3 µmol/L reduced the risk for ischemic heart disease, deep vein thrombosis, and stroke by 16%, 25%, and 24%, respectively.
The team concludes that further randomized controlled trials or longitudinal studies to determine the effect of folic acid and other B-vitamins on cardiovascular outcomes in the diabetic population are warranted.
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