Folate supplementation inhibits intimal hyperplasia induced by a high-homocysteine diet in a rat carotid endarterectomy model Todd P. Smith, MDa,b, Carlos.

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Folate supplementation inhibits intimal hyperplasia induced by a high-homocysteine diet in a rat carotid endarterectomy model Todd P. Smith, MDa,b, Carlos P. Cruz, MDa,b, Aliza T. Brown, PhDa,b, John F. Eidt, MDa,b, Mohammed M. Moursi, MDa,b Journal of Vascular Surgery Volume 34, Issue 3, Pages 474-481 (September 2001) DOI: 10.1067/mva.2001.117144 Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 Plasma folate and homocysteine levels for each diet group. Mean ± SE for plasma folate and homocysteine measured 2 weeks after carotid endarterectomy. LC, Lab chow; H(e), homocysteine; + 10, 10 mg/kg folate added; + 25, 25 mg/kg folate added. Asterisk indicates statistically significant difference between H(e) and H(e) + 10; number sign indicates statistically significant difference between H(e) and H(e) + 25. Journal of Vascular Surgery 2001 34, 474-481DOI: (10.1067/mva.2001.117144) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 Regression analysis of plasma folate versus homocysteine. Plasma folate and homocysteine measured 2 weeks after carotid endarterectomy. Relationship is inversely correlated at P =.0036 with R = 0.39. Journal of Vascular Surgery 2001 34, 474-481DOI: (10.1067/mva.2001.117144) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 Intimal hyperplasia (% luminal stenosis) for each diet group. Data are means + SE. Dietary homocysteine increased post–carotid endarterectomy intimal hyperplasia. This increase is attenuated with folate supplementation. Homocysteine with 25 mg/kg folate added resulted in intimal hyperplasia levels no different from lab chow groups. Asterisk equals statistically significant difference between H(e) and H(e) + 10; number sign equals statistically significant difference between H(e) and H(e) + 25. Journal of Vascular Surgery 2001 34, 474-481DOI: (10.1067/mva.2001.117144) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 4 Representative section of elastin-stained carotid artery from each diet group 2 weeks after carotid endarterectomy (10× magnification). Arrows indicate extent of intimal hyperplasia. A, Lab chow = 6.4% intimal hyperplasia. B, Lab chow + 10 mg/kg folate = 1.6% intimal hyperplasia. C, Lab chow + 25 mg/kg folate = 8.3% intimal hyperplasia. D, Homocysteine diet = 58.5% intimal hyperplasia. E, Homocysteine diet + 10 mg/kg folate = 35.5% intimal hyperplasia. F, Homocysteine diet + 25 mg/kg folate = 11.8% intimal hyperplasia. IH, Intimal hyperplasia. Journal of Vascular Surgery 2001 34, 474-481DOI: (10.1067/mva.2001.117144) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 5 Regression analysis of plasma homocysteine versus intimal hyperplasia. Plasma homocysteine concentrations were measured 2 weeks after carotid endarterectomy. Degree of intimal hyperplasia is presented as percent luminal stenosis. Increasing levels of plasma homocysteine and intimal hyperplasia are positively correlated at R = 0.8 with P <.0001. Journal of Vascular Surgery 2001 34, 474-481DOI: (10.1067/mva.2001.117144) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions