Homocysteine-lowering interventions for preventing cardiovascular events
Abstract
BACKGROUND: Cardiovascular disease, which includes coronary artery disease, stroke and congestive heart failure, is a leading cause of death worldwide. Homocysteine is an amino acid with biological functions in methionine metabolism. A postulated risk factor is an elevated circulating total homocysteine level, which is associated with cardiovascular events. The impact of homocysteine-lowering interventions, given to patients in the form of vitamins B6, B9 or B12 supplements, on cardiovascular events. This is an update of a review previously published in 2009 and 2013. OBJECTIVES: To determine whether homocysteine-lowering interventions, provided in patients with and without pre-existing cardiovascular disease are effective in preventing cardiovascular events, as well as all-cause mortality and evaluate their safety. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 1), MEDLINE (1950 to January week 5 2014), EMBASE (1980 to 2014 week 6) and LILACS (1986 to February 2014). We also searched Web of Science (1970 to 7 February 2014). We handsearched the reference lists of included papers. We also contacted researchers in the field. There was no language restriction in the search. SELECTION CRITERIA: We included randomised controlled trials assessing the effects of homocysteine-lowering interventions for preventing cardiovascular events with a follow-up period of one year or longer. We considered myocardial infarction and stroke as the primary outcomes. We excluded studies in patients with end-stage renal disease. DATA COLLECTION AND ANALYSIS: We performed study selection, 'Risk of bias' assessment and data extraction in duplicate. We estimated risk ratios (RR) for dichotomous outcomes. We measured statistical heterogeneity using the I(2) statistic. We used a random-effects model. MAIN RESULTS: In this second updated Cochrane Review, we identified no new randomised controlled trials. Therefore, this new version includes 12 randomised controlled trials involving 47,429 participants. In general terms, 75% (9/12) trials had a low risk of bias. Homocysteine-lowering interventions compared with placebo did not significantly affect non-fatal or fatal myocardial infarction (1743/23,590 (7.38%) versus 1247/20,190 (6.17%); RR 1.02, 95% confidence interval (CI) 0.95 to 1.10, I(2) = 0%, high quality evidence), stroke (968/22,348 (4.33%) versus 974/18,957 (5.13%); RR 0.91, 95% CI 0.82 to 1.0, I(2) = 11%, high quality evidence) or death from any cause (2784/22,648 (12.29%) versus 2502/19,250 (10.64%); RR 1.01, 95% CI 0.96 to 1.07, I(2) = 6%, high quality evidence). Homocysteine-lowering interventions compared with placebo did not significantly affect serious adverse events (cancer) (1558/18,130 (8.59%) versus 1334/14,739 (9.05%); RR 1.06, 95% CI 0.98 to 1.13; I(2) = 0%, high quality evidence). AUTHORS' CONCLUSIONS: This second update of this Cochrane Review found no evidence to suggest that homocysteine-lowering interventions in the form of supplements of vitamins B6, B9 or B12 given alone or in combination should be used for preventing cardiovascular events. Furthermore, there is no evidence to suggest that homocysteine-lowering interventions are associated with an increased risk of cancer.
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Therapies for lowering the concentration of homocysteine through vitamin supplementation did not result in the suppression of events.
“However, therapies for lowering the concentration of homocysteine through vitamin supplementation did not result in the suppression of events292, 293).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [292]
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- Authors
- Martí-Carvajal, A. J., Solà, I., & Lathyris, D.
- Affiliations
- Cochrane (BR)
- General Hospital of Athens G. Genimatas (GR)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- John Wiley & Sons, Ltd
- Published
- 2015-01-15
- Volume
- 1
- Pages
- CD006612-CD006612
- ISSN
- 1361-6137 (ISSN-L)
- OpenAlex
- W4210957338
- Cited by
- 113
- References
- 173
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 7 · 2022: 5 · 2021: 5 · 2020: 7 · 2019: 10 · 2018: 16 · 2017: 17 · 2016: 26 · 2015: 11 · 2014: 1 · 2013: 1
- Type
- reference entry
- Language
- en
- Update notices
- new_version (2017-08-17)
- Open access
- closed
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Folate and B Vitamins Research
- Health Sciences › Medicine › Physiology › Biochemical effects in animals
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- homocysteine, cardiovascular events, myocardial infarction, stroke, vitamin B6, folic acid, vitamin B12, methionine metabolism, all-cause mortality, cardiovascular risk factors, stroke prevention, coronary artery disease, congestive heart failure, drug safety, risk of bias
- MeSH terms
- Angina Pectoris, Cardiovascular Diseases, Humans, Myocardial Infarction, Risk Factors, Vitamin B Complex, Randomized Controlled Trials as Topic, Hyperhomocysteinemia, Stroke
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