| Title | Homocysteine lowering and cardiovascular events after acute myocardial infarction. | | Author(s) | Bønaa KH, Njølstad I, Ueland PM, Schirmer H, Tverdal A, Steigen T, Wang H, Nordrehaug JE, Arnesen E, Rasmussen K, NORVIT Trial Investigators | | Institution | Institute of Community Medicine, University of Tromsø, Tromsø, Norway. kaare.bonaa@stolav.no | | Source | N Engl J Med 2006 Apr 13; 354(15):1578-88. | | MeSH | Adult
Aged
Aged, 80 and over
Cerebrovascular Accident
Death, Sudden, Cardiac
Double-Blind Method
Drug Therapy, Combination
Female
Folic Acid
Humans
Hyperhomocysteinemia
Male
Middle Aged
Myocardial Infarction
Proportional Hazards Models
Recurrence
Research Support, Non-U.S. Gov't
Vitamin B 12
Vitamin B 6
| | 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.). | | Language | eng | | Pub Type(s) | Journal Article
Multicenter Study
Randomized Controlled Trial
| | PubMed ID | 16531614 |
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