COMMENTARY

Homocysteine-Lowering B Vitamins Do Not Lower Mortality or Cardiovascular Events

 


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This is the Medscape Medical Minute. I'm Dr. George Lundberg.

Some studies have reported an association between circulating total homocysteine levels and cardiovascular diseases. Oral folic acid and vitamin B-12 can lower plasma homocysteine. Nine investigators from Norway report in JAMA in 2008 on a randomized, double-blind, controlled trial involving 3096 adults undergoing coronary angiography.[1] The patients had a mix of double- and triple-vessel disease, stable angina pectoris, and/or acute coronary syndrome. With an intervention of oral folic acid, vitamin B-12, and/or vitamin B-6, after 1 year the mean plasma total homocysteine level was reduced by 30%. Problem is that after a median follow-up of 38 months, the primary endpoint of all-cause death, acute myocardial infarction, thromboembolic stroke, and/or hospitalization for unstable angina was 13.0% to 14.3% in all groups, including placebo. Use of these 3 B vitamins for secondary prevention did not work.

This article is selected from Medscape Best Evidence.[2] I'm Dr. George Lundberg.

 


 

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