Resumen de Hiperhomocisteinemia como factor de riesgo cardiovascular en pacientes en hemodiálisis: estudio prospectivo y aleatorizado con ácido fólico y vitaminas C, B12 y B6
María Pilar Martín Azara, Pablo Íñigo, Ignacio Ariño Galve, Beatriz Bergasa Liberal, Rafael Álvarez Lipe, J. Cebollada
Introduction. Hyperhomocysteinemia is a new risk factor for cardiovascular disease involved in the aterogenetic process. It is not very clear its role on hemodialysis patients, and the effect on homocysteine values of the therapy with folic acid and vitamin B12. Aim. To analyze the effect of the treatment with vitamin C added to standard hyperhomocysteine therapy. Patients and methods. Aleatory, double-blind study in 46 patients on hemodialysis therapy with a follow-up of 6 months; 21 with placebo and 25 treated with folic acid (5 mg/day), hydroxycobalamin (10 μg/day), pyridoxin (10 mg/day) and vitamin C (200 mg/day). We determine the C677T MTHR gene polymorphism and we evaluated Hcy, vitamins, C-reactive protein, fibrinogen, malonildialdehid, von Willebrand factor, carotid intima-media thickness and cardiovascular events. Results. The presence of the mutant alele CT and TT shows higher Hcy levels than CC group (p = 0.08), after treatment during 6 months these differences dissapeared. Hcy levels decreased a 41% in the group of treatment. A significant relationship was found between Hcy and iPTH (p = 0,01). The carotid intima-media thickness was higher in placebo group than in the treatment group (p = 0,02). In logistic regression Lp(a) (p = 0.02) and albumin (p = 0.03), show a positive significance as cardiovascular event markers. Treatment and cardiovascular mortality were not correlated. Conclusions. Albumin and Lp(a) could be used as risk markers of cardiovascular events on hemodialysis patients. The results show that the therapy with folic acid and vitamins could improve the arteriosclerotic status, although this intervention did not change cardiovascular mortality during the follow-up.
