Folic acid does not improve surrogate markers of early atherosclerosis in atorvastatin-treated patients

Homocysteine lowering with folic acid has been shown to be ineffective in reducing vascular events in patients with established cardiovascular disease. However, it may be beneficial in the early stages of atherosclerosis particularly for the population at risk. We have investigated the effect of folic acid administration on homocysteine levels, endothelial function, and leukocyte adhesion molecules in atorvastatin-treated patients. Thirty-nine patients were randomized to folic acid 5 mg daily or no additional treatment. Plasma total homocysteine levels were determined by high-performance liquid chromatography. Biochemical and hematologic tests were performed using routine automated analyzer methods. We examined the expression of l-selectin (CD62L); α-subunits of integrins LFA-1 (CD11a), Mac-1 (CD11b), and VLA-4 (CD49d); and β-subunit of β-2 integrins (CD18) by an immunofluorescence method using single-step staining of whole blood with monoclonal antibodies. The fluorescence was quantified by flow cytometry. Reactivity of the forearm skin microvascular bed to thermal and ischemic stimuli was measured using laser Doppler flowmetry. Postocclusive and thermal reactive hyperemia tests were performed. Statistical analysis used 2-sample t test and paired t test. Homocysteine levels decreased significantly in the folic acid–treated group (11.78 ± 2.7 vs 9.75 ± 1.89 μmol/L, P < .0001) but did not change in the control group (11.17 ± 2.09 vs 11.88 ± 2.88 μmol/L). There was no effect of folic acid treatment on leukocyte expression of cell adhesion molecules or microvascular reactivity. The lack of effect of folic acid on microvascular reactivity and leukocyte adhesion molecules supports the evidence against the beneficial effects of folic acid administration in the early stages of atherogenesis.