Veteran Affairs Boston Healthcare System, Department of Medicine, Boston, MA, USA.
Nutr Metab Cardiovasc Dis. 2013 Sep;23(9):836-42. doi: 10.1016/j.numecd.2012.07.002. Epub 2012 Aug 16.
BACKGROUND & AIMS: Hyperhomocysteinaemia (HHCY), a common finding in patients with chronic kidney disease (CKD), has been shown to contribute to adverse cardiac remodelling and failure. We hypothesised that in human subjects with CKD, HHCY would be associated with myocardial dysfunction, and that homocysteine (HCY)-lowering therapy would improve myocardial remodelling and heart-failure (HF) outcomes.
Post hoc analysis of the Homocysteinemia in Kidney and End Stage Renal Disease (HOST) trial (n=2056) was performed to determine if HCY-lowering therapy with high dose B vitamins affects HF outcomes in patients with CKD. In addition, effects on myocardial remodelling were assessed in a subgroup of 220 trial subjects who had transthoracic echocardiograms done before study randomisation and during the course of the study as part of their routine clinical care. HF outcomes were not significantly affected by treatment compared to the placebo. HCY levels were inversely correlated with diastolic function (R=-0.21; p=0.038). Vitamin therapy resulted in a significant increase in left atrial size (+0.15±0.8 cm vs. -0.13±0.07 cm; p=0.0095). No other echocardiographic parameters were significantly associated with baseline HCY levels or changes with vitamin therapy.
HHCY is associated with diastolic dysfunction in patients with CKD. However, B-vitamin therapy did not improve HF outcomes despite lowering of plasma HCY levels, and was associated with an increase in left atrial size, which is a surrogate for worsening left ventricular diastolic dysfunction. These findings suggest that high-dose B vitamin therapy may be harmful in patients with CKD.
高同型半胱氨酸血症（HHcy）是慢性肾脏病（CKD）患者的常见现象，已被证明可导致不良的心脏重构和衰竭。我们假设在 CKD 患者中，HHcy 与心肌功能障碍有关，而降低同型半胱氨酸（HCY）的治疗可以改善心肌重构和心力衰竭（HF）的结局。
对 Homocysteinemia in Kidney and End Stage Renal Disease（HOST）试验（n=2056）进行了事后分析，以确定高剂量 B 族维生素降低 HCY 的治疗是否会影响 CKD 患者的 HF 结局。此外，在 220 名试验受试者的亚组中评估了心肌重构的影响，这些受试者在研究随机分组前和研究过程中进行了经胸超声心动图检查，作为其常规临床护理的一部分。与安慰剂相比，治疗对 HF 结局没有显著影响。HCY 水平与舒张功能呈负相关（R=-0.21；p=0.038）。维生素治疗导致左心房大小显著增加（+0.15±0.8 cm 与-0.13±0.07 cm；p=0.0095）。其他超声心动图参数与基线 HCY 水平或维生素治疗变化均无显著相关性。
HHcy 与 CKD 患者的舒张功能障碍有关。然而，尽管降低了血浆 HCY 水平，B 族维生素治疗并没有改善 HF 结局，而且与左心房大小的增加有关，这是左心室舒张功能恶化的替代指标。这些发现表明，高剂量 B 族维生素治疗可能对 CKD 患者有害。
