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 .
Folic Acid Therapy Reduces the First Stroke Risk Associated With Hypercholesterolemia Among Hypertensive Patients
Background and Purpose — We sought to determine whether folic acid supplementation can independently reduce the risk of first stroke associated with elevated total cholesterol levels in a sub analysis using data from the CSPPT ( China Stroke Primary Prevention Trial ) , a double-blind , r and omized controlled trial . Methods — A total of 20 702 hypertensive adults without a history of major cardiovascular disease were r and omly assigned to a double-blind daily treatment of an enalapril 10-mg and a folic acid 0.8-mg tablet or an enalapril 10-mg tablet alone . The primary outcome was first stroke . Results — The median treatment duration was 4.5 years . For participants not receiving folic acid treatment ( enalapril-only group ) , high total cholesterol ( ≥200 mg/dL ) was an independent predictor of first stroke when compared with low total cholesterol ( < 200 mg/dL ; 4.0 % versus 2.6 % ; hazard ratio , 1.52 ; 95 % confidence interval , 1.18–1.97 ; P=0.001 ) . Folic acid supplementation significantly reduced the risk of first stroke among participants with high total cholesterol ( 4.0 % in the enalapril-only group versus 2.7 % in the enalapril – folic acid group ; hazard ratio , 0.69 ; 95 % confidence interval , 0.56–0.84 ; P<0.001 ; number needed to treat , 78 ; 95 % confidence interval , 52–158 ) , independent of baseline folate levels and other important covariates . By contrast , among participants with low total cholesterol , the risk of stroke was 2.6 % in the enalapril-only group versus 2.5 % in the enalapril – folic acid group ( hazard ratio , 1.00 ; 95 % confidence interval , 0.75–1.30 ; P=0.982 ) . The effect was greater among participants with elevated total cholesterol ( P for interaction=0.024 ) . Conclusions — Elevated total cholesterol levels may modify the benefits of folic acid therapy on first stroke . Folic acid supplementation reduced the risk of first stroke associated with elevated total cholesterol by 31 % among hypertensive adults without a history of major cardiovascular diseases . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique 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 .