Abstract
The aim of the present study was to conduct an updated meta-analysis of relevant randomized controlled trials (RCTs) in order to estimate the effect of folic acid supplementation on endothelial function and the concentration of plasma homocysteine in patients with coronary artery disease (CAD). An extensive search of PubMed was conducted to identify RCTs that compared folic acid with placebo therapy. The mean difference (MD) and 95% confidence interval (CI) were used as a measure of the correlation between folic acid supplementation and endothelial function/plasma homocysteine concentration. Of the 377 patients included in this analysis, 191 patients underwent folic acid supplementation and 186 individuals underwent placebo treatment. Compared with the use of a placebo, folic acid supplementation alone exhibited significant efficacy on increasing flow-mediated dilation (FMD; MD, 57.72 μm; 95% CI, 50.14–65.31; P<0.05) and lowering the concentration of plasma homocysteine (MD, −3.66 μmol/l; 95% CI, −5.44–−1.87; P<0.05; I2, 87%). There was no significant change in the response to end diastolic diameter, glyceryl-trinitrate diameter, heart rate, baseline and peak hyperemic flow and systolic and diastolic blood pressure between the folic acid and placebo groups (P>0.05). Therefore, the meta-analysis indicated that 5 mg folic acid daily supplementation for >4 weeks significantly improved FMD and lowered the concentration of plasma homocysteine in patients with CAD. However, more RCTs are required in order to confirm these observations.
Highlights
Endothelial dysfunction is closely associated with the occurrence and development of atherosclerotic disease and numerous studies have confirmed that coronary artery disease (CAD) is often accompanied by endothelial dysfunction [1,2]
The results of the present meta‐analysis demonstrated that an increase in flow‐mediated dilation (FMD) and decrease in plasma homocysteine concentration in CAD patients were associated with folic acid supplementation
There was no significant change in end diastolic diameter (EDD), GTN diameter, heart rate, baseline and peak hyperemic flow and systolic and diastolic blood pressure (BP) between the folic acid supplementation and placebo‐treated groups
Summary
Endothelial dysfunction is closely associated with the occurrence and development of atherosclerotic disease and numerous studies have confirmed that coronary artery disease (CAD) is often accompanied by endothelial dysfunction [1,2]. A number of studies have demonstrated that hyperhomocysteinemia, one of the risk factors of CAD, promotes the occurrence and development of CAD by damaging vascular endothelial function [3,4,5]. Whether long‐term high‐dose folic acid (5 mg daily) alone may effectively improve vascular endothelial function and lower the concentration of plasma homocysteine in patients with CAD remains controversial [10,11,12]. A meta‐analysis of randomized controlled trials (RCTs) with regard to folic acid treatment for CAD was performed to verify whether folic acid is capable of improving endothelial function and reducing the concentration of plasma homocysteine in patients with CAD
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