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 .
Cardiovascular effects of B-vitamins and/or N-3 fatty acids: the SU.FOL.OM3 trial.
BACKGROUND Mechanisms involved in coronary stenosis evolution are different than those involved in clinical events . Because of differential vascular effects , N-3 polyunsatured fatty acids ( PUFA ) and B vitamins could have differential effects on different types of cardiovascular clinical events in high-risk patients . METHODS We analyzed the effects of n-3 PUFA and of B vitamins on both coronary revascularization and on hard coronary events risks in a subgroup of the SU.FOL.OM3 trial , a r and omized , double-blind , placebo-controlled secondary prevention trial . Data were analyzed according to the intention-to-treat principle , with the use of Cox proportional-hazards models . RESULTS After a mean follow-up of 4.2 ± 1.0 years among the 1,863 participants with coronary heart disease , 163 coronary revascularizations were performed , and 95 patients experienced a hard coronary event . Neither treatment with n-3 PUFA , nor treatment with B vitamins was associated with any significant effect on the occurrence of hard coronary events . Allocation to n-3 PUFA was not associated with any significant effect on coronary revascularization . However , treatment with B vitamins was associated with a statistically significant 52 % increase in the risk of coronary revascularization ( multivariate HR : 1.52 ; 95 % CI : [ 1.11 - 2.10 ] ; p=0.01 ) . CONCLUSIONS Neither n-3 PUFA , nor B vitamins  reduced the rates of hard coronary events and of coronary revascularization .  Furthermore , B vitamins  significantly increased the rate of coronary revascularization . Consistent with the findings of previous trials , our results do not support the routine use of dietary supplements containing n-3 PUFA and argue against using dietary supplements containing B-vitamins in coronary patients in secondary cardiovascular prevention
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 .