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Homocysteine lowering and cardiovascular events after acute myocardial infarction.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Bønaa, Kaare Harald Njølstad, Inger Ueland, Per Magne Schirmer, Henrik Tverdal, Aage Wang, Harald Nordrehaug, Jan Erik Arnesen, Egil Rasmussen, Knut |
| Copyright Year | 2006 |
| Abstract | BACKGROUND Homocysteine is a risk factor for cardiovascular disease. We evaluated the efficacy of homocysteine-lowering treatment with B vitamins for secondary prevention in patients who had had an acute myocardial infarction. METHODS The trial included 3749 men and women who had had an acute myocardial infarction within seven days before randomization. Patients were randomly assigned, in a two-by-two factorial design, to receive one of the following four daily treatments: 0.8 mg of folic acid, 0.4 mg of vitamin B12, and 40 mg of vitamin B6; 0.8 mg of folic acid and 0.4 mg of vitamin B12; 40 mg of vitamin B6; or placebo. The primary end point during a median follow-up of 40 months was a composite of recurrent myocardial infarction, stroke, and sudden death attributed to coronary artery disease. RESULTS The mean total homocysteine level was lowered by 27 percent among patients given folic acid plus vitamin B12, but such treatment had no significant effect on the primary end point (risk ratio, 1.08; 95 percent confidence interval, 0.93 to 1.25; P=0.31). Also, treatment with vitamin B6 was not associated with any significant benefit with regard to the primary end point (relative risk of the primary end point, 1.14; 95 percent confidence interval, 0.98 to 1.32; P=0.09). In the group given folic acid, vitamin B12, and vitamin B6, there was a trend toward an increased risk (relative risk, 1.22; 95 percent confidence interval, 1.00 to 1.50; P=0.05). CONCLUSIONS Treatment with B vitamins did not lower the risk of recurrent cardiovascular disease after acute myocardial infarction. A harmful effect from combined B vitamin treatment was suggested. Such treatment should therefore not be recommended. (ClinicalTrials.gov number, NCT00266487.). |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://vhpharmsci.com/decisionmaking/therapeutic_decision_making/intermediate_files/norvit-homocysteine%20lowering%20and%20cardiovascular%20events%20after%20acute%20myocardial%20infarction-nejm.pdf |
| Alternate Webpage(s) | http://folk.uib.no/mfapu/Pages/papers%20pdf/2006/bonaa_06_nejm_354_1578.pdf |
| PubMed reference number | 16531614v1 |
| Volume Number | 354 |
| Issue Number | 15 |
| Journal | The New England journal of medicine |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Arteriopathic disease Cardiovascular Diseases Cerebrovascular accident Confidence Intervals Coronary Artery Disease Folic Acid Homocysteine measurement Myocardial Infarction Patients PersonNameUse - assigned Secondary Prevention Sudden death Vitamin B 12 Vitamin B Complex Vitamin B6 |
| Content Type | Text |
| Resource Type | Article |
