Therefore , although the overall effect of metformin on the concentration of serum Hcy was neutral , our results suggested that metformin could increase the concentration of Hcy when exogenous B-group vitamins or folic acid supplementation was not given
The aim of this systematic review is to assess whether metformin could change the concentration of serum homocysteine ( Hcy ) with and without simultaneous supplementation of B-group vitamins or folic acid .
Plasma Homocysteine Predicts Mortality Independently of Traditional Risk Factors and C-Reactive Protein in Patients With Angiographically Defined Coronary Artery Disease
Background Plasma homocysteine ( tHCY ) has been associated with coronary artery disease ( CAD ) . We tested whether tHCY also increases secondary risk , after initial CAD diagnosis , and whether it is independent of traditional risk factors , C-reactive protein ( CRP ) , and methylenetetrahydrofolate reductase ( MTHFR ) genotype . Methods and Results Blood sample s were collected from 1412 patients with severe angiographically defined CAD ( stenosis ≥70 % ) . Plasma tHCY was measured by fluorescence polarization immunoassay . The study cohort was evaluated for survival after a mean of 3.0±1.0 years of follow-up ( minimum 1.5 years , maximum 5.0 years ) . The average age of the patients was 65±11 years , 77 % were males , and 166 died during follow-up . Mortality was greater in patients with tHCY in tertile 3 than in tertiles 1 and 2 ( mortality 15.7 % versus 9.6 % , P = 0.001 [ log-rank test ] , hazard ratio [ HR ] 1.63 ) . The relative hazard increased 16 % for each 5-&mgr;mol/L increase in tHCY ( P < 0.001 ) . In multivariate Cox regression analysis , controlling for univariate clinical and laboratory predictors , elevated tHCY remained predictive of mortality ( HR 1.64 , P = 0.009 ) , together with age ( HR 1.72 per 10-year increment , P < 0.0001 ) , ejection fraction ( HR 0.84 per 10 % increment , P = 0.0001 ) , diabetes ( HR 1.98 , P = 0.001 ) , CRP ( HR 1.42 per tertile , P = 0.004 ) , and hyperlipidemia . Homozygosity for the MTHFR variant was weakly predictive of tHCY levels but not mortality . Conclusions In patients with angiographically defined CAD  , tHCY is a significant predictor of mortality , independent of traditional risk factors , CRP , and MTHFR genotype . These findings increase interest in tHCY as a secondary risk marker and in secondary prevention trials ( ie , with folate/B vitamins ) to determine whether reduction in tHCY will reduce risk
Therefore , although the overall effect of metformin on the concentration of serum Hcy was neutral , our results suggested that metformin could increase the concentration of Hcy when exogenous B-group vitamins or folic acid supplementation was not given
The aim of this systematic review is to assess whether metformin could change the concentration of serum homocysteine ( Hcy ) with and without simultaneous supplementation of B-group vitamins or folic acid .