W Mei1, Y Rong, L Jinming, L Yongjun, Z Hui. 1. Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Abstract
AIMS: To evaluate the effects of homocysteine lowering intervention on the risk of cardiocerebrovascular events and all-cause mortality in randomised controlled trials among people with preexisting cardiocerebrovascular or renal disease. METHODS: Studies were retrieved by searching MEDLINE and OVID (from January 1966 to December 2008) using the following keywords: homocysteine, hyperhomocysteinaemia, cardiovascular disease, coronary disease, cerebrovascular disease, B vitamins, folic acid, randomised controlled trial. References of all retrieved articles were also searched. Randomised controlled trials which compared folic acid or plus B vitamins supplementation with either placebo or usual care were evaluated with cardiocerebrovascular disease events or all-cause mortality reported as an end-point. Data on study design, characteristics of participants, changes in homocysteine levels, and cardiocerebrovascular events and all-cause mortality were independently abstracted by two investigators using a standardised protocol. RESULTS: Seventeen trials involving 39,107 patients with preexisting cardiocerebrovascular or renal disease were included. Results of meta-analyses showed that no significant differences were identified between the intervention group and the control group. The overall relative risks (95% confidence intervals) of outcomes for patients treated with folic acid or plus B vitamins supplementation compared with controls were 1.01 (0.97-1.05) for cardiovascular events, 1.01 (0.94-1.07) for coronary heart disease, 0.94 (0.85-1.04) for stroke and 1.00 (0.95-1.05) for all-cause mortality. In the exclusion of low-quality trials and seven trials in grain fortification countries respectively, sensitivity analyses did not change the overall results. CONCLUSION: There is no sufficient evidence to show that homocysteine lowering intervention can reduce the risk of cardiocerebrovascular diseases or all-cause mortality among people with preexisting vascular disease. Folic acid supplementation should not be recommended for the secondary prevention of cardiocerebrovascular diseases. More evidence from large-scale randomised controlled trials is needed to confirm this.
AIMS: To evaluate the effects of homocysteine lowering intervention on the risk of cardiocerebrovascular events and all-cause mortality in randomised controlled trials among people with preexisting cardiocerebrovascular or renal disease. METHODS: Studies were retrieved by searching MEDLINE and OVID (from January 1966 to December 2008) using the following keywords: homocysteine, hyperhomocysteinaemia, cardiovascular disease, coronary disease, cerebrovascular disease, B vitamins, folic acid, randomised controlled trial. References of all retrieved articles were also searched. Randomised controlled trials which compared folic acid or plus B vitamins supplementation with either placebo or usual care were evaluated with cardiocerebrovascular disease events or all-cause mortality reported as an end-point. Data on study design, characteristics of participants, changes in homocysteine levels, and cardiocerebrovascular events and all-cause mortality were independently abstracted by two investigators using a standardised protocol. RESULTS: Seventeen trials involving 39,107 patients with preexisting cardiocerebrovascular or renal disease were included. Results of meta-analyses showed that no significant differences were identified between the intervention group and the control group. The overall relative risks (95% confidence intervals) of outcomes for patients treated with folic acid or plus B vitamins supplementation compared with controls were 1.01 (0.97-1.05) for cardiovascular events, 1.01 (0.94-1.07) for coronary heart disease, 0.94 (0.85-1.04) for stroke and 1.00 (0.95-1.05) for all-cause mortality. In the exclusion of low-quality trials and seven trials in grain fortification countries respectively, sensitivity analyses did not change the overall results. CONCLUSION: There is no sufficient evidence to show that homocysteine lowering intervention can reduce the risk of cardiocerebrovascular diseases or all-cause mortality among people with preexisting vascular disease. Folic acid supplementation should not be recommended for the secondary prevention of cardiocerebrovascular diseases. More evidence from large-scale randomised controlled trials is needed to confirm this.
Authors: Ellen M Mowry; Emmanuelle Waubant; Charles E McCulloch; Darin T Okuda; Alan A Evangelista; Robin R Lincoln; Pierre-Antoine Gourraud; Don Brenneman; Mary C Owen; Pamela Qualley; Monica Bucci; Stephen L Hauser; Daniel Pelletier Journal: Ann Neurol Date: 2012-08 Impact factor: 10.422
Authors: Meg J Jardine; Amy Kang; Sophia Zoungas; Sankar D Navaneethan; Toshiharu Ninomiya; Sagar U Nigwekar; Martin P Gallagher; Alan Cass; Giovanni Strippoli; Vlado Perkovic Journal: BMJ Date: 2012-06-13
Authors: Kelly M Bakulski; Sung Kyun Park; Marc G Weisskopf; Katherine L Tucker; David Sparrow; Avron Spiro; Pantel S Vokonas; Linda Huiling Nie; Howard Hu; Jennifer Weuve Journal: Environ Health Perspect Date: 2014-06-06 Impact factor: 9.031