Related Experiment Video

Updated: Jul 13, 2026

The Antihypertensive Effects and Mechanisms of Huotan Jiedu Tongluo Decoction in Rats with H-Type Hypertension
05:57

The Antihypertensive Effects and Mechanisms of Huotan Jiedu Tongluo Decoction in Rats with H-Type Hypertension

Published on: May 17, 2024

Homocysteine lowering and cardiovascular disease risk: lost in translation

Jeremy Marcus1, Mark J Sarnak, Vandana Menon

  • 1Department of Medicine, Division of Nephrology, Tufts-New England Medical Centre, Boston, Massachusetts 02111, USA.

The Canadian Journal of Cardiology
|July 12, 2007
PubMed

Insights

High homocysteine levels are linked to cardiovascular issues, especially in kidney disease patients. However, studies show homocysteine-lowering vitamins do not reduce cardiovascular risk in these populations.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Trials

Background:

  • Elevated homocysteine is linked to cardiovascular disease (CVD) in the general population.
  • In chronic kidney disease (CKD), homocysteine levels increase, correlating with higher CVD risk.
  • The association between homocysteine and CVD in CKD is complex and may be confounded by kidney function.

Purpose of the Study:

  • To evaluate the impact of homocysteine-lowering vitamins on cardiovascular outcomes in patients with and without kidney failure.
  • To determine if screening for and treating hyperhomocysteinemia is beneficial in CKD populations.

Main Methods:

  • Review of multiple large-scale randomized controlled trials (RCTs) and smaller RCTs.
  • Analysis of data from patients with pre-existing cardiovascular disease and patients with kidney failure.
  • Assessment of interventions using folate, vitamin B6, and vitamin B12.

Main Results:

  • Large RCTs in patients with cardiovascular disease and smaller RCTs in kidney failure patients did not demonstrate cardiovascular benefits from homocysteine-lowering vitamins.
  • Some studies suggest lower homocysteine levels predict mortality in kidney failure patients, contrary to general population findings.
  • The association between homocysteine and cardiovascular risk in CKD is often attenuated when kidney function is considered.

Conclusions:

  • Current evidence does not support routine screening for hyperhomocysteinemia in CKD.
  • Treatment with homocysteine-lowering vitamins is not recommended for cardiovascular risk reduction in these patient groups based on available data.
  • Further interventional trials are ongoing, but existing data are insufficient to change clinical practice regarding hyperhomocysteinemia management.

More Related Videos

Cell-free Biochemical Fluorometric Enzymatic Assay for High-throughput Measurement of Lipid Peroxidation in High Density Lipoprotein07:29

Cell-free Biochemical Fluorometric Enzymatic Assay for High-throughput Measurement of Lipid Peroxidation in High Density Lipoprotein

Published on: October 12, 2017

Related Concept Videos

Atherosclerosis III: Management01:26

Atherosclerosis III: Management

Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers01:19

Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers

Cardiac biomarkers are critical in diagnosing, prognosing, and managing cardiovascular diseases. Routine measurement of specific biomarkers such as B-type natriuretic peptide (BNP), C-reactive protein (CRP), and homocysteine (Hcy) is common practice in clinical settings to evaluate heart function and predict cardiovascular events.
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
Pharmacogenomics: Identification of New Drug Targets01:29

Pharmacogenomics: Identification of New Drug Targets

Advances in genomics have profoundly influenced drug discovery by increasing both the speed and accuracy of pharmaceutical development. Pharmacogenomics, which examines how genetic variation influences drug response, facilitates the identification of novel therapeutic targets and enables patient stratification for personalized treatment. These strategies contribute to improved drug efficacy, minimized adverse effects, and more efficient clinical trial design.Mapping genetic differences...
Coronary Artery Disease IV: Preventive Measures01:26

Coronary Artery Disease IV: Preventive Measures

Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
Lipid-Lowering Drugs: Statins and Miscellaneous Agents01:20

Lipid-Lowering Drugs: Statins and Miscellaneous Agents

Hyperlipidemia, a medical condition often referred to as high cholesterol, is characterized by abnormally elevated levels of lipids in the bloodstream. When present in excess, these lipids, specifically cholesterol and triglycerides, can lead to serious health complications, often involving cardiovascular diseases. Illnesses like atherosclerosis, heart attacks, and pancreatitis have all been linked to untreated hyperlipidemia. This means controlling and regulating cholesterol and triglyceride...
Pharmacogenetic Phenotypes: Alterations in Pharmacokinetics, Drug Targets and Biologic Milieu01:29

Pharmacogenetic Phenotypes: Alterations in Pharmacokinetics, Drug Targets and Biologic Milieu

Genetic variations significantly influence drug response through pharmacokinetics, receptor interactions, and biologic milieu modifications. Pharmacokinetic alterations impact drug metabolism and clearance, affecting efficacy and toxicity. Variants in drug-metabolizing enzymes, such as CYP2C9 and CYP2C19, alter drug activation and elimination. For example, CYP2C9 loss-of-function variants require lower warfarin doses to prevent excessive bleeding, while CYP2C19 variants reduce clopidogrel...