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 .
Homocysteine-Lowering Treatment With Folic Acid, Cobalamin, and Pyridoxine Does Not Reduce Blood Markers of Inflammation, Endothelial Dysfunction, or Hypercoagulability in Patients With Previous Transient Ischemic Attack or Stroke: A Randomized Substudy of the VITATOPS Trial
Background and Purpose — Epidemiological and laboratory studies suggest that increasing concentrations of plasma homocysteine ( total homocysteine [ tHcy ] ) accelerate cardiovascular disease by promoting vascular inflammation , endothelial dysfunction , and hypercoagulability . Methods — We conducted a r and omized controlled trial in 285 patients with recent transient ischemic attack or stroke to examine the effect of lowering tHcy with folic acid 2 mg , vitamin B12 0.5 mg , and vitamin B6 25 mg compared with placebo on laboratory markers of vascular inflammation , endothelial dysfunction , and hypercoagulability . Results — At 6 months after r and omization , there was no significant difference in blood concentrations of markers of vascular inflammation ( high-sensitivity C-reactive protein [ P=0.32 ] ; soluble CD40L [ P=0.33 ] ; IL-6 [ P=0.77 ] ) , endothelial dysfunction ( vascular cell adhesion molecule-1 [ P=0.27 ] ; intercellular adhesion molecule-1 [ P=0.08 ] ; von Willebr and factor [ P=0.92 ] ) , and hypercoagulability ( P-selectin [ P=0.33 ] ; prothrombin fragment 1 and 2 [ P=0.81 ] ; D-dimer [ P=0.88 ] ) among patients assigned vitamin therapy compared with placebo despite a 3.7-&mgr;mol/L ( 95 % CI , 2.7 to 4.7 ) reduction in total homocysteine ( tHcy ) . Conclusions — Lowering tHcy by 3.7 & mgr;mol/L with folic acid-based multivitamin therapy does not significantly reduce blood concentrations of the biomarkers of inflammation , endothelial dysfunction , or hypercoagulability measured in our study . The possible explanations for our findings are : ( 1 ) these biomarkers are not sensitive to the effects of lowering tHcy ( eg , multiple risk factor interventions may be required ) ; ( 2 ) elevated tHcy causes cardiovascular disease by mechanisms other than the biomarkers measured ; or ( 3 ) elevated tHcy is a noncausal marker of increased vascular risk
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 .