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 .
A dose-finding trial of the effect of long-term folic acid intervention: implications for food fortification policy.
BACKGROUND The lowest dose of folic acid required to achieve effective reductions in homocysteine is controversial but important for food fortification policy given recent concerns about the potential adverse effects of overexposure to this vitamin . OBJECTIVE We compared the effectiveness of 0.2 mg folic acid/d with that of 0.4 and 0.8 mg/d at lowering homocysteine concentrations over a 6-mo period . DESIGN A r and omized dose-finding trial with folic acid was conducted . Of 203 participants screened , 101 patients with ischemic heart disease and 71 healthy volunteers completed the study . Participants were r and omly assigned to receive placebo or folic acid at doses of 0.2 , 0.4 , or 0.8 mg/d for 26 wk ; sub sample s of patients with ischemic heart disease were also examined at 6 or 12 wk . RESULTS Participants with higher baseline homocysteine concentrations had the greatest reductions in homocysteine in response to folic acid doses of 0.2 mg ( -20.6 % ) , 0.4 mg ( -20.7 % ) , and 0.8 mg ( -27.8 % ) ; in those with lower baseline homocysteine concentrations , the responses were -8.2 % , -8.9 % , and -8.3 % , respectively . No significant differences in homocysteine responses to the different doses were observed . In the patient group sample d at intervals during the intervention , the maximal homocysteine response appeared to be achieved by 6 wk in the 0.8-mg/d group and by 12 wk in the 0.4-mg/d group . However , the homocysteine response was suboptimal in the 0.2-mg/d group at both 6 and 12 wk compared with that at 26 wk . CONCLUSIONS A folic acid dose as low as 0.2 mg/d can , if administered for 6 mo , effectively lower homocysteine concentrations . Higher doses may not be necessary because they result in no further significant lowering , whereas doses even lower than 0.2 mg/d may be effective in the longer term . Previous trials probably overestimated the folic acid dose required because of a treatment duration that was too short . This trial was registered at clinical trials.gov as IS RCT N45296887
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 .