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 .
Secondary prevention with folic acid: effects on clinical outcomes.
OBJECTIVES We sought to conduct a r and omized trial with folic acid 0.5 mg/day in a patient population with stable coronary artery disease ( CAD ) . BACKGROUND Folic acid has favorable effects on vascular endothelium and lowers plasma homocysteine levels . In addition , homocysteine appears to be an independent risk factor for atherosclerotic disease . However , the value of folic acid in secondary prevention had seldom been tested . METHODS In this open-label study , 593 patients were included ; 300 were r and omized to folic acid and 293 served as controls .  Mean follow-up time was 24 months . At baseline all patients had been on statin therapy for a mean of 3.2 years . RESULTS In patients treated with folic acid , plasma homocysteine levels decreased by 18 % , from 12.0 + /- 4.8 to 9.4 + /- 3.5 micromol/l , whereas these levels remained unaffected in the control group ( p < 0.001 between groups ) . The primary end point ( all-cause mortality and a composite of vascular events ) was encountered in 31 ( 10.3 % ) patients in the folic acid group and in 28 ( 9.6 % ) patients in the control group ( relative risk 1.05 ; 95 % confidence interval : 0.63 to 1.75 ) . In a multifactorial survival model with adjustments for clinical factors , the most predictive laboratory parameters were , in order of significance , levels of creatinine clearance , plasma fibrinogen , and homocysteine . CONCLUSIONS Within two years , folic acid does not seem to reduce clinical end points in patients with stable coronary artery disease ( CAD ) while on statin treatment . Homocysteine might therefore merely be a modifiable marker of disease . Thus , low-dose folic acid supplementation should be treated with reservation , until more trial outcomes become available
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 .