Homocysteine lowering interventions for preventing cardiovascular events

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.