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 .
Dose-dependent effects of folic acid on plasma homocysteine in a randomized trial conducted among 723 individuals with coronary heart disease.
AIMS To determine the effects on homocysteine levels of two doses of folic acid compared to placebo , where the high dose is typical of that provided by pharmacological intervention and the low dose approximates that provided by dietary supplementation . METHODS AND RESULTS The PACIFIC study was a double-blind , placebo-controlled , factorial r and omized trial . Seven hundred and twenty-three individuals with a history of myocardial infa rct ion or unstable angina were recruited from 28 clinical cardiology centres in Australia and New Zeal and and r and omized to folic acid 2.0 mg daily , folic acid 0.2 mg daily or placebo . The primary outcome , homocysteine , was measured using a fluorescence polarization immunoassay . Compared to placebo , 2.0 mg folic acid  reduced homo-cysteine by 1.8 micromol x 1(-1 ) [ 95 % confidence interval ( CI ) 1.3 - 2.3 ] and 0.2 mg reduced homocysteine by 1.2 micromol x 1(-1 ) [ 95 % CI 0.8 - 1.7 ) . The higher dose reduced homocysteine significantly more than the lower dose ( P=001 ) . CONCLUSIONS Both doses of folic acid  reduced homocysteine , but the effects of the 2.0 mg dose were about one third greater than the 0.2 mg dose . Fortification of foods with folic acid should result in population -wide lower levels of homocysteine but high-dose pharmacological supplementation would produce greater reductions for high-risk individuals
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 .