AN EVALUATION ON THE EFFECT OF FOLIC ACID ON SERUM HOMOCYSTEINE LEVEL, LEFT VENTRICULAR FUNCTION AND 6-MONTHS MORTALITY OF DIABETIC PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

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POURMOGHADAS A.; TAHERI P.; AMINI MASOUD; SANEI H.; POORMOGHADAS M.; SHOLEVAR M.

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Paper Information

Journal: JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S) Year:2005 | Volume:23 | Issue:76 Page(s): 20-24

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Title

AN EVALUATION ON THE EFFECT OF FOLIC ACID ON SERUM HOMOCYSTEINE LEVEL, LEFT VENTRICULAR FUNCTION AND 6-MONTHS MORTALITY OF DIABETIC PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

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Keywords

DIABETES TYPE 2Q2

HOMOCYSTEINEQ3

HYPERHOMOCYSTEINEMIAQ4

ACUTE MYOCARDIAL INFARCTION (AMI)Q3

FOLIC ACIDQ3

Abstract

Introduction: About 75% of all cases of DIABETES TYPE 2 die because of coronary artery diseases. The basic pathogenesis of this disease in vascular complications is endothelial cell dysfunction. One of the risk factors of this pathophysiology is HOMOCYSTEINE; a metabolite of diary methionine HYPERHOMOCYSTEINEMIA leads to a higher risk of ischemic myocardial injury in acute coronary syndromes. Otherwise, HYPERHOMOCYSTEINEMIA occurs after acute myocardial infarction (AMI). FOLIC ACID effectively lowers the serum HOMOCYSTEINE level. Thus the authors arranged a study to compare the efficacy of FOLIC ACID on serum HOMOCYSTEINE level, ejection fraction and mortality of diabetic patients with recent AMI in a 6-months period.Materials and methods: After selecting 60 diabetic cases (type 2) with AMI who referred to Noor Hospital in Isfahan, subjects were randomly divided into case and control groups, both undergoing the same medical therapy. Serum HOMOCYSTEINE level and ejection fraction were measured in all of the subjects. Patients in the case group were prescribed 1 mg FOLIC ACID tablets, daily for a minimum period of 6 months, in addition to medications prescribed for patients in the control group. After 6 months, all patients were called for measurement of serum HOMOCYSTEINE level and ejection fraction. Mortality rate in each group was evaluated and the data pertaining to each group were analyzed using T-test.Results: Six-month mortality rate was compared between the two groups. Two patients from the case group (6.7% of the case group) and 4 patients from the control group (13.3% of the control group) died. Despite no statistically significant difference between the two groups, mortality rate in the control group was twice as high. In the case group, we found a significantly decreased serum HOMOCYSTEINE level (19.42±7.72 µmol/liter at the beginning of the study and 12.57±4.839 µmol/liter after 6 months) (P<0.001). Analysis of data in the control group showed a significant increase in serum HOMOCYSTEINE level (19.98±10.75 µmol/liter at the beginning of the study and 21.39±10.58 µmol/liter after 6 months) (P=0.033). Mean differences of serum HOMOCYSTEINE in the case and control groups were -6.75±3.88 and 1.67±3.86 µmol/liter, respectively; the difference in serum HOMOCYSTEINE level between the two groups 6 months after AMI was highly significant (P<0.001). Comparison of change in ejection fraction between the two groups revealed no statistical significance (P=0.26). However, the rise in ejection fraction within each of the two groups (EF2-1) was significant (P<0.001 in the case group and P=0.016 in the control group).Conclusion: Although we could not demonstrate the efficacy of FOLIC ACID in improving left heart function and reducing mortality rate, we revealed that FOLIC ACID lowered serum HOMOCYSTEINE level, which is a risk factor for endothelial dysfunction. Thus, we recommend routine use of FOLIC ACID in diabetic patients with recent AMI. A long-term follow up involving a greater number of subjects is warranted to determine the effect of FOLIC ACID on mortality rate.

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