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 and all-cause mortality in hypertensive adults without pre-existing cardiovascular conditions
Background : Previous studies support an association between elevated total homocysteine ( tHcy ) levels and increased all-cause mortality . However , few prospect i ve studies have examined this association in hypertensive patients , and /or tested any effect modification by the methylene tetrahydrofolate reductase ( MTHFR ) C677 T genotype . Methods : This was a post hoc analysis of the China Stroke Primary Prevention Trial . Serum tHcy and folate were measured at baseline . Individual MTHFR C677 T genotype ( CC , CT , and TT ) was determined . Evidence for death included death certificates or home visits . Cumulative hazards of all-cause mortality by tHcy quartiles were estimated using the Kaplan – Meier method , and group differences were compared by log-rank tests . Hazard ratios ( HRs ) and 95 % confidence intervals were estimated by Cox proportional-hazard regression models , adjusting for age , sex , baseline folate , vitamin B12 , blood pressure , body mass index , smoking and alcohol drinking status , study center , total cholesterol , triglycerides , high-density lipoprotein cholesterol , fasting glucose , creatinine , and treatment group . Potential effect modification by the MTHFR genotype on the relationship between tHcy and all-cause mortality was tested . Results : The analyses included 20,424 hypertensive patients ( 41 % males ) without a history of myocardial infa rct ion or stroke . Baseline mean age ( SD ) was 60 ± 7.5 years and mean ( SD ) serum tHcy was 14.5 ± 8.4 & mgr;mol/L. After a mean follow-up period of 4.5 years , there were 612 ( 3 % ) all-cause deaths . Kaplan – Meier survival curves revealed a grade d relationship between tHcy quartiles and all-cause mortality . The HRs , using the lowest quartile as the reference , were 1.2 , 1.2 , and 1.5 in Q2 , Q3 , and Q4 , respectively . A linear trend test , using natural log-transformed tHcy , result ed in an HR of 1.5 ( 95 % confidence interval 1.2–1.9 , P < .001 ) after adjustment for lifestyle and health-related variables . Whereas the MTHFR genotype alone had little effect on mortality , it significantly modified the tHcy – mortality association , which was much stronger in the CC/CT genotype than in the TT genotype ( P for interaction < 0.05 ) . Conclusions : Among Chinese hypertensive patients without cardiovascular comorbidities , elevated tHcy was a significant risk marker for death from all causes , and the association was subject to effect modification by MTHFR genotypes . If confirmed that tHcy and MTHFR genotypes may serve as useful biomarkers for mortality risk assessment and targeted intervention
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 .