Effect of folate administration on heart allograft atherosclerosis one year after transplant: a prospective randomized study

Abstract

or detection of a new coronary lesion after a mean observation period of 2.8 1.0 years. A multivariate analysis (backward logistic regression) was performed including potential risk factors for CAVD (see below). Patients on dialysis were excluded. Results: Initially plasma homocysteine levels were elevated in the entire cohort (mean 19.3 8.3 mol/L) and ranged from 6.6 to 56.4 mol/L. A total number of 106 patients (57,9%) presented with CAVD at first angiography and progression was detected in 51 transplant recipients (28%). Patients with progressive CAVD presented with significantly higher plasma homocysteine levels (21.7 6.3 mol/L) at baseline investigation as compared to those with a stable course (17.4 7.7 mol/L) (p 0.001). These results were independent of parameters like gender, age, time after transplantation, dyslipoproteinemia, cyclosporine blood levels, initial indication for transplantation and severity of CAVD at baseline examination. Conclusions: Progress of cardiac allograft vasculopathy is strongly associated with elevated plasma homocysteine levels. The intervals of routine surveillance angiography should be shortened in patients with hyperhomocysteinemia and medical treatment to lower elevated homocysteine is recommended in these patients.