In this third up date of the Cochrane review , there were no differences in effects of homocysteine-lowering interventions in the form of supplements of vitamins B6 , B9 or B12 given alone or in combination comparing with placebo on myocardial infa rct ion , death from any cause or adverse events .
BACKGROUND Cardiovascular disease , which includes coronary artery disease , stroke and peripheral vascular disease , is a leading cause of death worldwide .
Homocysteine is an amino acid with biological functions in methionine metabolism .
A postulated risk factor for cardiovascular disease is an elevated circulating total homocysteine level .
The impact of homocysteine-lowering interventions , given to patients in the form of vitamins B6 , B9 or B12 supplements , on cardiovascular events has been investigated .
This is an up date of a review previously published in 2009 , 2013 , and 2015 .
OBJECTIVES To determine whether homocysteine-lowering interventions , provided to patients with and without pre-existing cardiovascular disease are effective in preventing cardiovascular events , as well as reducing all-cause mortality , and to evaluate their safety .
B Vitamins and Magnetic Resonance Imaging–Detected Ischemic Brain Lesions in Patients With Recent Transient Ischemic Attack or Stroke: The VITAmins TO Prevent Stroke (VITATOPS) MRI-Substudy
Background and Purpose — Elevated concentrations of homocysteine are associated with cerebral small vessel disease ( CSVD ) . b-vitamin supplementation with folate and vitamins b12 and b6 reduces homocysteine concentrations . In a sub study of the VITAmins TO Prevent Stroke ( VITATOPS ) trial , we assessed the hypothesis that the addition of once-daily supplements of b vitamins would reduce the progression of CSVD-related brain lesions . Methods — A total of 359 patients with recent stroke or transient ischemic attack , who were r and omly allocated to double-blind treatment with placebo or b vitamins , underwent brain MRI at r and omization and after 2 years of b-vitamin supplementation . MR images were analyzed blinded to treatment allocation . Outcomes related to the prespecified hypothesis were progression of white matter hyperintensities and incident lacunes . We also explored the effect of b-vitamin supplementation on the incidence of other ischemic abnormalities . Results — After 2 years of treatment with b vitamins or placebo , there was no significant difference in white matter hyperintensities volume change ( 0.08 vs 0.13cm3 ; P=0.419 ) and incidence of lacunes ( 8.0 % vs 5.9 % , P=0.434 ; odds ratio=1.38 ) . In a sub analysis of patients with MRI evidence of severe CSVD at baseline , b-vitamin supplementation was associated with a significant reduction in white matter hyperintensities volume change ( 0.3 vs 1.7cm3 ; P=0.039 ) . Conclusions — Daily b-vitamin supplementation for 2 years did not significantly reduce the progression of brain lesions result ing from presumed CSVD in all patients with recent stroke or transient ischemic attack but may do so in the subgroup of patients with recent stroke or transient ischemic attack and severe CSVD . Clinical Trial Registration — http://vitatops.highway1.com.au/. Unique identifier : NCT00097669 and IS RCT N74743444
In this third up date of the Cochrane review , there were no differences in effects of homocysteine-lowering interventions in the form of supplements of vitamins B6 , B9 or B12 given alone or in combination comparing with placebo on myocardial infa rct ion , death from any cause or adverse events .
BACKGROUND Cardiovascular disease , which includes coronary artery disease , stroke and peripheral vascular disease , is a leading cause of death worldwide .
Homocysteine is an amino acid with biological functions in methionine metabolism .
A postulated risk factor for cardiovascular disease is an elevated circulating total homocysteine level .
The impact of homocysteine-lowering interventions , given to patients in the form of vitamins B6 , B9 or B12 supplements , on cardiovascular events has been investigated .
This is an up date of a review previously published in 2009 , 2013 , and 2015 .
OBJECTIVES To determine whether homocysteine-lowering interventions , provided to patients with and without pre-existing cardiovascular disease are effective in preventing cardiovascular events , as well as reducing all-cause mortality , and to evaluate their safety .