Related Experiment Video
Updated: Jun 19, 2026
The Antihypertensive Effects and Mechanisms of Huotan Jiedu Tongluo Decoction in Rats with H-Type Hypertension
Published on: May 17, 2024
Homocysteine lowering interventions for preventing cardiovascular events
Arturo J Martí-Carvajal1, Ivan Solà, Dimitrios Lathyris
1Iberoamerican Cochrane Network, Valencia, Edo. Carabobo, Venezuela, 2001.
Insights
Homocysteine-lowering interventions (HLI) do not reduce the risk of cardiovascular events. This meta-analysis found no evidence to support HLI for preventing heart attacks or strokes.
Area of Science:
- Cardiovascular Science
- Nutritional Science
- Clinical Trials
Background:
- Cardiovascular disease is a leading global cause of death.
- Elevated total homocysteine (tHcy) is a potential risk factor, influenced by vitamins B12, B9, and B6.
- The association between tHcy and cardiovascular disease risk requires further clarification.
Purpose of the Study:
- To evaluate the clinical effectiveness of homocysteine-lowering interventions (HLI).
- To assess HLI's impact on preventing cardiovascular events in diverse patient groups.
Main Methods:
- Conducted a comprehensive literature search across multiple databases (CENTRAL, MEDLINE, EMBASE, LILACS, AMED, Web of Science).
- Included randomized clinical trials (RCTs) with a minimum 1-year follow-up, excluding end-stage renal disease patients.
- Performed independent data extraction and risk of bias assessment, synthesizing findings using a random-effects model.
Main Results:
- Analyzed eight RCTs with 24,210 participants, generally showing a low risk of bias.
- HLI did not significantly reduce the risk of non-fatal or fatal myocardial infarction (pooled RR 1.03).
- No significant reduction was observed for stroke (pooled RR 0.89) or all-cause mortality (pooled RR 1.00).
Conclusions:
- Current evidence from published trials does not support the use of HLI for cardiovascular event prevention.
- HLI, despite lowering homocysteine levels, do not appear to confer cardiovascular benefits.
Background:
Cardiovascular disease such as coronary artery disease, stroke and congestive heart failure, is a leading cause of death worldwide. A postulated risk factor is elevated circulating total homocysteine (tHcy) levels which is influenced mainly by blood levels of cyanocobalamin (vitamin B12), folic acid (vitamin B9) and pyridoxine (vitamin B6). There is uncertainty regarding the strength of association between tHcy and the risk of cardiovascular disease.
Objectives:
To assess the clinical effectiveness of homocysteine-lowering interventions (HLI) in people with or without pre-existing cardiovascular disease.
Search Strategy:
We searched The Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (issue 3 2008), MEDLINE (1950 to August 2008), EMBASE (1988 to August 2008), and LILACS (1982 to September 2, 2008). We also searched in Allied and Complementary Medicine (AMED; 1985 to August 2008), ISI Web of Science (1993 to August 2008), and the Cochrane Stroke Group Specialised Register (April 2007). We hand searched pertinent journals and 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 clinical trials (RCTs) assessing the effects of HLI for preventing cardiovascular events with a follow-up period of 1 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 independently performed study selection, risk of bias assessment and data extraction. We estimated relative risks (RR) for dichotomous outcomes. We measured statistical heterogeneity using I(2). We used a random-effects model to synthesise the findings.
Main Results:
We included eight RCTs involving 24,210 participants with a low risk of bias in general terms. HLI did not reduce the risk of non-fatal or fatal myocardial infarction, stroke, or death by any cause (pooled RR 1.03, 95% CI 0.94 to 1.13, I(2) = 0%; pooled RR 0.89, 95% CI 0.73 to 1.08, I(2) = 15%); and pooled RR 1.00 (95% CI 0.92 to 1.09, I(2): 0%), respectively.
Authors' Conclusions:
Results from available published trials suggest that there is no evidence to support the use of HLI to prevent cardiovascular events.
Related Concept Videos
01:26Atherosclerosis III: Management
01:26Coronary Artery Disease IV: Preventive Measures
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:28Hypertension IV: Drug Therapy and Lifestyle Modifications
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins