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 when added to statin therapy in patients with hypercholesterolemia following acute myocardial infarction: a randomised pilot trial.
BACKGROUND Folic acid is assumed to have favourable effects on vascular endothelium , directly as well as indirectly through its effect on homocysteine metabolism . However , the clinical value of folic acid in secondary prevention after acute myocardial infa rct ion ( MI ) has never been tested . Thus , a r and omised , open-label , multicentre trial was performed in order to study the effect of folic acid 5 mg o.d . when added to statin therapy on the incidence of recurrent major clinical events up to 1 year post-MI . METHODS A total of 283 patients with a total cholesterol > 6.5 mmol/l ( 251 mg/dl ) ( mean 7.3 mmol/l ) were included . All patients received 40 fluvastatin .  In 140 of the 283 patients , folic acid ( 5 mg o.d . ) was instituted at discharge , and the remaining 143 patients served as controls . Other secondary prevention measures for both groups were advocated . The primary endpoint was a composite consisting of all vascular events , including death , recurrent MI , strokes , and unplanned invasive coronary interventions . RESULTS At baseline , the two groups were well-matched for all clinical and demographic parameters . After 1 year of treatment , no difference was noticed in the primary endpoint between the two groups . These endpoints occurred in 43 patients ( 31 % ) in the folic acid group , as opposed to 45 patients ( 31 % ) in the control group . All separate cardiovascular events were also equally distributed between both groups . Total cholesterol levels decreased to a similar extent in the two groups ( to 5.5 and 5.7 mmol/l , in folic acid and control groups , respectively ) . CONCLUSIONS In this medium-size pilot study , folic acid did not demonstrate any beneficial additive effects on cardiovascular mortality or morbidity in post-MI patients with hypercholesterolemia who were treated with statin therapy .  Larger trials , possibly targeting at selected population s , must be awaited before definitive conclusions regarding the potentially favourable effects of folic acid supplementation in secondary prevention can be drawn
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 .