Folic acid and vitamin B12 are more effective than vitamin B6 in lowering fasting plasma homocysteine concentration in patients with coronary artery disease

Eur J Clin Nutr. 2004 Mar;58(3):481-7. doi: 10.1038/sj.ejcn.1601834.


Objective: To investigate whether vitamin B(6) supplementation had a beneficial effect on lowering fasting plasma homocysteine concentrations in coronary artery disease (CAD) patients.

Design: A single-blind intervention study.

Setting: The study was performed at the Taichung Veterans General Hospital, the central part of Taiwan.

Subjects: A total of 50 subjects were identified by cardiac catheterization to have at least 70% stenosis of one major coronary artery. In all, 42 patients successfully completed this study.

Interventions: Patients were randomly assigned to one of five groups and treated with a daily dose of placebo (n=8), 5 mg vitamin B(6) (n=8), 10 mg vitamin B(6) (n=8), 50 mg vitamin B(6) (n=9), or 5 mg folic acid combined with 0.25 mg vitamin B(12) (n=9) for 12 weeks.

Main outcome measures: Nutrient intakes were recorded by using 24-h diet recalls when patients returned to the cardiology clinic before the intervention (week 0) and at week 12. Vitamin B(6) status was assessed by direct measures (plasma pyridoxal 5'-phosphate) and indirect measures (erythrocyte alanine and aspartate aminotransaminase activity coefficient). Fasting plasma homocysteine, serum folic acid, and vitamin B(12) were measured.

Results: Fasting plasma homocysteine concentration did not respond to high or low doses of vitamin B(6) when compared with a placebo treatment after 12 weeks of supplementation. The mean fasting plasma homocysteine concentration, however, decreased significantly after 12 weeks of folic acid combined with vitamin B(12) supplementation (P=0.047). Further, within group, mean fasting plasma homocysteine concentration was nonsignificantly increased by 25.5, 16.2, and 18.3% in placebo, 10 mg/day and 50 mg/day vitamin B(6) supplemented groups, respectively; whereas folic acid combined with vitamin B(12) supplementation significantly reduced fasting plasma homocysteine concentration by 32% (P<0.001).

Conclusions: Our results indicate that vitamin B(6) supplementation alone is less effective than folic acid combined with vitamin B(12) in lowering plasma homocysteine concentrations in CAD patients.

Sponsorship: This study was supported by the National Science Council, Taiwan, Republic of China (NSC-91-2320-B-040-023).

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Coronary Artery Disease / blood*
  • Dose-Response Relationship, Drug
  • Female
  • Folic Acid / administration & dosage*
  • Folic Acid / blood
  • Homocysteine / blood*
  • Humans
  • Male
  • Mental Recall
  • Middle Aged
  • Single-Blind Method
  • Treatment Outcome
  • Vitamin B 12 / administration & dosage*
  • Vitamin B 12 / blood
  • Vitamin B 6 / administration & dosage*
  • Vitamin B 6 / blood


  • Homocysteine
  • Vitamin B 6
  • Folic Acid
  • Vitamin B 12