Folic Acid, Vitamin B₆, and Vitamin B₁₂in Combination and Age-Related Cataract in a Randomized Trial of Women

Abstract

Purpose To examine incidence of cataract and cataract extraction in a trial of folic acid and vitamins B6 and B12. Methods In a randomized, double-masked, placebo-controlled trial, 5,442 female health professionals aged 40 years or older with preexisting cardiovascular disease (CVD) or 3 or more CVD risk factors were randomly assigned to receive a combination of folic acid (2.5mg/day), vitamin B6 (50mg/day), and vitamin B12 (1mg/day), or placebo. A total of 3,925 of these women did not have a diagnosis of cataract at baseline and were included in this analysis. The primary endpoint was age-related cataract, defined as an incident age-related lens opacity, responsible for a reduction in best-corrected visual acuity to 20/30 or worse, based on self-report confirmed by medical record review. Extraction of incident age-related cataract was a secondary endpoint of the trial. Results During an average of 7.3 years of treatment and follow-up, 408 cataracts and 275 cataract extractions were documented. There were 215 cataracts in the combination treatment group and 193 in the placebo group (hazard ratio, HR, 1.10, 95% confidence interval, CI, 0.90–1.33; P=0.36). For the secondary endpoint of cataract extraction, there were 155 in the combination treatment group and 120 in the placebo group (HR 1.28, 95% CI 1.01–1.63; P=0.04). Conclusions In this large-scale randomized trial of women at high risk of CVD, daily supplementation with a combination of folic acid, vitamin B6, and vitamin B12 had no significant effect on cataract, but may have increased the risk of cataract extraction.

Nutritional Strategies to Prevent Lens Cataract: Current Status and Future Strategies

“…Furthermore, in large, prospective, population-based cohorts it was found that high-dose Vitamin C or Vitamin E supplements had a statistically significant increased risk of age-related cataract [15], most likely due to the pro-oxidative properties of Vitamins C and E at high doses reported in in vitro studies [16,17]. While in a large-scale randomized trial of women at high risk of cardiovascular disease, daily supplementation with a combination of folic acid, vitamin B 6 , and vitamin B 12 had no significant effect on cataract, but may have increased the risk of cataract extraction [18]. However, high intake of dietary vitamin K 1 was associated with a reduced risk of cataracts in an elderly Mediterranean population even after adjusting by other potential confounders [19].…”

Increased risk of ischemic heart disease among subjects with cataracts

“…[ 1 – 4 ] Cataract is a common cause of visual impairment in the elderly population; reduced antioxidant and oxidative stress are associated with the pathogenesis of senile cataract. [ 5 – 12 ]…”

Anti-VEGF Drugs Influence Epigenetic Regulation and AMD-Specific Molecular Markers in ARPE-19 Cells

“…To date, 6 epigenetic drugs have been approved by the FDA for cancer therapy [ 51 ]. A variety of epigenetic drugs, including DNMT and HDAC inhibitors are currently under investigation as potential therapeutic agents in AMD, owing to their ability to reverse inflammation and angiogenesis [ 55 , 86 ]. Specific HDAC inhibitors might be preferable to pan-inhibitors, such as TSA, as the latter can cause undesirable alterations in gene expression by inducing histone hyperacetylation [ 53 ].…”