Folate Therapy and In-Stent Restenosis after Coronary Stenting

Some studies have shown that the use of folate supplementation to lower plasma homocysteine levels reduces the rate of restenosis in patients who have undergone angioplasty, but results have been inconsistent. In this study, patients who had received a coronary stent were randomly assigned to receive placebo or a combination of folate, vitamin B 6 , and vitamin B 12 . Those receiving active therapy had a higher rate of in-stent restenosis. Those receiving active therapy had a higher rate of in-stent restenosis. Homocysteine is believed to be a risk factor for coronary artery disease. 1 , 2 Folate supplementation is a cost-effective way to treat hyperhomocysteinemia. 3 , 4 Studies in animals have shown that homocysteine levels are related to the risk of restenosis after carotid angioplasty, 5 , 6 because high levels promote thrombogenicity 7 , 8 and neointimal proliferation. 9 In rats, folate supplementation lowered homocysteine levels and inhibited neointimal hyperplasia after carotid endarterectomy. 10 In humans, data regarding homocysteine levels and the risk of restenosis after coronary angioplasty have been conflicting. 11 – 18 The recent finding that the rate of restenosis was significantly reduced after coronary angioplasty among patients who . . .