Effect of folic acid combined with pravastatin on arteriosclerosis in elderly hypertensive patients with lacunar infarction

Abstract

This study aimed to assess the effect of folic acid combined with pravastatin on atherosclerosis-related indexes in elderly patients with hypertension complicated with lacunar cerebral infarction. A total of 134 elderly hypertensive patients with lacunar cerebral infarction were randomly divided into 3 groups using the random number table method. Group A, the folic acid group, had 45 cases and received low-dose folic acid (0.8 mg/d) treatment on the basis of antihypertensive treatment. Group B, the pravastatin group, had 45 cases and received pravastatin (20 mg/d) treatment on the basis of antihypertensive treatment. Group C, the folic acid combined with the pravastatin group, had 44 cases. Members of this group received pravastatin (20 mg/d) and low-dose folic acid (0.8 mg/d) based on antihypertensive treatment. Levels of folic acid, homocysteine (Hcy), tumor necrosis factor alpha (TNF-a), matrix metallopeptidase 9 (MMP-9), cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) were measured by ELISA before treatment in all 3 groups. Carotid intima-media thickness (IMT) was measured using ultrasound, and systolic and diastolic blood pressure were measured with a mercury column. After 8 weeks of treatment, the levels of folic acid, Hcy, TNF-a, MMP-9, TC, LDL-C, and systolic and diastolic blood pressure were compared among the 3 groups. IMT levels were measured at 12 weeks of treatment. After 8 weeks of treatment, compared with group B, patients in groups A and C had folic acid levels significantly higher than baseline levels, with significantly lower Hcy levels (both P < .05). Patients in group C presented significantly decreased TNF-a, MMP-9, TC, and LDL-C levels and systolic and diastolic blood pressure after 8 weeks of treatment, compared with those in groups A and B (both P < .05). These patients also showed significantly decreased IMT levels compared with those in the other groups ( P < .05). Low-dose folic acid combined with pravastatin in elderly patients with lacunar cerebral infarction can reduce the level of homocysteine, improve the degree of carotid atherosclerosis, protect vascular endothelium, and reduce blood lipids and blood pressure, presenting better benefits than pravastatin alone.

Hyperhomocysteinemia in Cardiovascular Diseases: Revisiting Observational Studies and Clinical Trials

“…84 Folic acid combined with pravastatin significantly decreased the carotid intima-media thickness, compared with placebo and folate alone, in elderly patients with hypertension. 89 Folic acid and vitamin B12 supplementation could reduce the recurrence rate of thrombosis in patients with lower extremity deep venous thrombosis and increased t-Hcy and cerebral infarction. 87 A RCT with B12, folic acid, and B6 reduced the incidence of thrombosis in military volunteers at 2 years of stay at high altitude, a condition at increased risk.…”

“…The most recent Cochrane systematic review and meta-analysis of the effect of t-Hcy lowering by B vitamin supplementation reviewed 15 RCTs of subjects with CHD and stroke as preexisting diseases ( Table 1 ). 64 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 The meta-analysis included RCTs evaluating the occurrence of myocardial infarction and stroke during at least 1 year in patients without end-stage renal disease. 64 This Cochrane meta-analysis observed a small reduction in stroke outcomes with high-quality evidence.…”

“…S1 [available in the online version]) ( Table 1 ). 64 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 The 5 to 7 year long-term effects of folic acid and vitamin-B12 supplementation had a null effect on CVD risk. 90 In contrast, the percent lowering in t-Hcy was significantly associated with a reduction in the risk of first stroke event in CSPPT Chinese adults with hypertension.…”

Association between Cerebral Small Vessel Disease and Plasma Levels of LDL Cholesterol and Homocysteine: Implications for Cognitive Function

“…Cerebral small vessel disease (CSVD) is predominantly characterized by the involvement of small arteries and veins, encompassing conditions such as small vessel disease of the white matter, microvascular disease, and blood-brain barrier disruption (1,2). Not only is CSVD a common etiology of cognitive decline and dementia in the elderly, but it is also closely associated with neurological impairments including stroke, motor disorders, and depression (3)(4)(5).…”