Homocysteine lowering with folic acid and B vitamins in vascular disease

被引:15
作者
Lonn, E
Yusuf, S
Arnold, MJ
Sheridan, P
Pogue, J
Micks, M
McQueen, MJ
Probstfield, J
Fodor, G
Held, C
Genest, J
机构
[1] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON L8S 4L8, Canada
[2] Hamilton Hlth Sci, Dept Med, Div Cardiol, Hamilton, ON, Canada
[3] Univ Western Ontario, Dept Med, Div Cardiol, London, ON, Canada
[4] Univ Washington, Sch Med, Seattle, WA USA
[5] Univ Ottawa, Inst Heart, Ottawa, ON, Canada
[6] Karolinska Univ Hosp, Dept Cardiol, Stockholm, Sweden
[7] McGill Univ, Div Cardiol, Ctr Hlth, Montreal, PQ H3A 2T5, Canada
[8] Royal Victoria Hosp, Montreal, PQ H3A 1A1, Canada
关键词
D O I
暂无
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: In observational studies, lower homocysteine levels are associated with lower rates of coronary heart disease and stroke. Folic acid and vitamins B(sub 6) and B(sub 12) lower homocysteine levels. We assessed whether supplementation reduced the risk of major cardiovascular events in patients with vascular disease. METHODS: We randomly assigned 5522 patients 55 years of age or older who had vascular disease or diabetes to daily treatment either with the combination of 2.5 mg of folic acid, 50 mg of vitamin B(sub 6), and 1 mg of vitamin B(sub 12) or with placebo for an average of five years. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, and stroke. RESULTS: Mean plasma homocysteine levels decreased by 2.4 micromol per liter (0.3 mg per liter) in the active-treatment group and increased by 0.8 micromol per liter (0.1 mg per liter) in the placebo group. Primary outcome events occurred in 519 patients (18.8 percent) assigned to active therapy and 547 (19.8 percent) assigned to placebo (relative risk, 0.95; 95 percent confidence interval, 0.84 to 1.07; P=0.41). As compared with placebo, active treatment did not significantly decrease the risk of death from cardiovascular causes (relative risk, 0.96; 95 percent confidence interval, 0.81 to 1.13), myocardial infarction (relative risk, 0.98; 95 percent confidence interval, 0.85 to 1.14), or any of the secondary outcomes. Fewer patients assigned to active treatment than to placebo had a stroke (relative risk, 0.75; 95 percent confidence interval, 0.59 to 0.97). More patients in the active-treatment group were hospitalized for unstable angina (relative risk, 1.24; 95 percent confidence interval, 1.04 to 1.49). CONCLUSIONS: Supplements combining folic acid and vitamins B(sub 6) and B(sub 12) did not reduce the risk of major cardiovascular events in patients with vascular disease.
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收藏
页码:1567 / 1577
页数:11
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