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 .
Efficacy of Folic Acid Therapy on the Progression of Chronic Kidney Disease: The Renal Substudy of the China Stroke Primary Prevention Trial.
Importance The efficacy of folic acid therapy on renal outcomes has not been previously investigated in population s without folic acid fortification . Objective To test whether treatment with enalapril and folic acid is more effective in slowing renal function decline than enalapril alone across a spectrum of renal function at baseline from normal to moderate chronic kidney disease ( CKD ) among Chinese adults with hypertension . Design , Setting , and Participants In this sub study of eligible China Stroke Primary Prevention Trial ( CSPPT ) , 15 104 participants with an estimated glomerular filtration rate ( eGFR ) 30 mL/min/1.73 m2 or greater , including 1671 patients with CKD , were recruited from 20 communities in Jiangsu province in China . Interventions Participants were r and omized to receive a single tablet daily containing 10 mg enalapril and 0.8 mg folic acid ( n = 7545 ) or 10 mg enalapril alone ( n = 7559 ) . Main Outcomes and Measures The primary outcome was the progression of CKD , defined as a decrease in eGFR of 30 % or more and to a level of less than 60 mL/min/1.73 m2 if the baseline eGFR was 60 mL/min/1.73 m2 or more , or a decrease in eGFR of 50 % or more if the baseline eGFR was less than 60 mL/min/1.73 m2 ; or end-stage renal disease . Secondary outcomes included a composite of the primary outcome and all-cause death , rapid decline in renal function , and rate of eGFR decline . Results Overall , 15 104 Chinese adults with a mean ( range ) age of 60 ( 45 - 75 ) years were recruited ; median follow-up was 4.4 years . There were 164 and 132 primary events in the enalapril group and the enalapril-folic acid group , respectively . Compared with the enalapril group , the enalapril-folic acid group had a 21 % reduction in the odds of the primary event ( odds ratio [ OR ] , 0.79 ; 95 % CI , 0.62 - 1.00 ) and a slower rate of eGFR decline ( 1.28 % vs 1.42 % per year ; P = .02 ) . Among the participants with CKD at baseline , folic acid therapy result ed in a significant reduction in the risks for the primary event ( OR , 0.44 ; 95 % CI , 0.26 - 0.75 ) , rapid decline in renal function ( OR , 0.67 ; 95 % CI , 0.47 - 0.96 ) and the composite event ( OR , 0.62 ; 95 % CI , 0.43 - 0.90 ) , and a 44 % slower decline in renal function ( 0.96 % vs 1.72 % per year , P < .001 ) . Among those without CKD at baseline , there was no between-group difference in the primary end point . Conclusions and Relevance Enalapril-folic acid therapy , compared with enalapril alone , can significantly delay the progression of CKD among patients with mild-to-moderate CKD . Trial Registration clinical trials.gov Identifier : NCT00794885
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 .