Homocysteine Lowering and Cardiovascular Events after Acute Myocardial Infarction

• Published in: The New England journal of medicine Vol. 354; no. 15; pp. 1578 - 1588
• Main Authors: Bønaa, Kaare Harald, Njølstad, Inger, Ueland, Per Magne, Schirmer, Henrik, Tverdal, Aage, Steigen, Terje, Wang, Harald, Nordrehaug, Jan Erik, Arnesen, Egil, Rasmussen, Knut
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 13.04.2006
• Subjects: Acids; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Coronary heart disease; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - prevention & control; Double-Blind Method; Drug Therapy, Combination; Female; Folic Acid - blood; Folic Acid - therapeutic use; General aspects; Heart; Heart attacks; Homocysteine; Humans; Hyperhomocysteinemia - complications; Hyperhomocysteinemia - drug therapy; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Myocardial Infarction - prevention & control; Proportional Hazards Models; Secondary Prevention; Stroke; Stroke - epidemiology; Vitamin B; Vitamin B 12 - blood; Vitamin B 12 - therapeutic use; Vitamin B 6 - blood; Vitamin B 6 - therapeutic use; Sulfur containing aminoacid; Myocardial infarction; Medicine; Thiol; Homocystein; Heart disease; Acute; Cardiovascular disease; Myocardial disease
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa055227

Observational reports have found that lower homocysteine levels are associated with lower rates of coronary heart disease and stroke. Treatment with folic acid and vitamin B 12 , with or without vitamin B 6 , lowers plasma homocysteine levels. In the NORVIT trial in patients after myocardial infarction, such therapy did not decrease the rate of recurrent infarction, stroke, and sudden death. After myocardial infarction, treatment with folic acid and vitamin B 12 , with or without vitamin B 6 , did not decrease the rate of recurrent infarction, stroke, and sudden death. Case–control as well as prospective studies have demonstrated that the plasma total homocysteine level is a strong, graded, and independent risk factor for coronary heart disease (CHD) and stroke. 1 – 3 Evidence from studies involving so-called mendelian randomization, 4 demonstrating an association between CHD and the 677C→T methylenetetrahydrofolate reductase polymorphism, has provided additional support for a causal relation between homocysteine and CHD. 5 , 6 Plasma total homocysteine can be lowered with the B vitamins folic acid and vitamin B 12 , 7 and persons with high plasma levels or dietary intake of folate and vitamin B 6 have a decreased risk of CHD. 8 – . . .