Homocysteine lowering and cardiovascular events after acute myocardial infarction
| Autor: | Henrik Schirmer, Jan Erik Nordrehaug, Egil Arnesen, Terje K. Steigen, Kaare H. Bønaa, Harald Wang, Knut Rasmussen, Per Magne Ueland, Aage Tverdal, Inger Njølstad |
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| Rok vydání: | 2006 |
| Předmět: |
Adult
Male medicine.medical_specialty Homocysteine Hyperhomocysteinemia Myocardial Infarction Gastroenterology Sudden death Coronary artery disease chemistry.chemical_compound Folic Acid Double-Blind Method Internal medicine medicine Secondary Prevention Humans Myocardial infarction Risk factor Aged Proportional Hazards Models Aged 80 and over business.industry General Medicine Middle Aged medicine.disease Vitamin B 6 Stroke B vitamins Vitamin B 12 Death Sudden Cardiac chemistry Relative risk Cardiology Myocardial infarction complications Drug Therapy Combination Female business |
| Zdroj: | The New England journal of medicine. 354(15) |
| ISSN: | 1533-4406 |
| Popis: | 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 twoby-two factorial design, to receive one of the following four daily treatments: 0.8 mg of folic acid, 0.4 mg of vitamin B 12 , and 40 mg of vitamin B 6 ; 0.8 mg of folic acid and 0.4 mg of vitamin B 12 ; 40 mg of vitamin B 6 ; 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 B 12 , 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 B 6 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 B 12 , and vitamin B 6 , 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.) |
| Databáze: | OpenAIRE |
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