Oral folic acid enhances endothelial function in patients with hypercholesterolaemia receiving statins

Background Folic acid therapy has been shown to improve endothelial function in patients with familial hypercholesterolaemia via a possible antioxidant mechanism. Data on the possible role of folic acid in hypercholesterolaemic patients receiving statins are lacking. In the present study we tested the hypothesis that folic acid supplementation improves endothelial function in patients with hypercholesterolaemia and treatment with statins. Methods Thirty-four hypercholesterolaemic patients receiving statins participated in the study; all subjects underwent measurement of endothelium-dependent, flow-mediated dilatation of the brachial artery and subsequently randomized to receive 5 mg of the folic acid (n=17) or placebo (n=17) for 4 weeks. Flow-mediated dilatation of the brachial artery was repeated at the end of the 4-week period. Results Folic acid and placebo groups were comparable regarding age, sex, smoking, hypertension, coronary artery disease, obesity, family history and blood lipids. Folic acid administration resulted in an improvement of flow-mediated dilatation (4.7 +/- 3.2% to 7.1 +/- 3.1 %, P= 0.02), whereas there was no improvement after placebo administration (5.7 +/- 3.8% to 5.6 +/- 2.2%, ns). No significant change in nitrate-induced, endothelium-independent dilatation was observed after folic acid or placebo (ns). Conclusions Oral administration of folic acid (5mg) for 4 weeks improves endothelial function in patients with hypercholesterolaemia treated with statins, with possible beneficial effects on the prognosis of these patients. (C) 2004 The European Society of Cardiology.