High of the same heights of homocy...

High of the same heights of homocysteine have been associated with atherosclerosis and cerebrovascular disease. single in kind meta-analysis indicated that even moderately elevated horizontals of homocysteine are an independent risk factor for cardiovascular disease. Folic acid, pyridoxine, and cobalamin are known to contract homocysteine levels. Toole and associates, onward behalf of the Vitamin Intervention for blow Prevention trial, investigated whether adding a multivitamin containing folic acid, pyridoxine, and cobalamin to optimal medical and surgical management of patients with nondisabling cerebral infarction and elevated homocysteine horizontals could reduce the incidence of returning cerebral infarction, as well as coronary heart disease (CHD) and death.

Patients with a presumptive diagnosis of pat with elevated homocysteine levels were included in this multi-center, randomized, double-blind, controll trial. Of the 3680 eligible adults, 1827 were randomized to a high-dose vitamin assemblage (25 mg pyridoxine, 0.4 mg cobalamin, 25 mg folic acid), while 1853 patients were randomized to a low-dose vitamin cluster (200 mcg pyridoxine, 6 mcg cobalamin, 20 mcg folic acid). Primary conclusion points included recurrent stroke, increased score forward the National Institutes of Health thump Scale, and death. Other extreme point points were myocardial infarction requiring hospitalization, coronary revascularization, cardiac resuscitation, and fatal CHD

The reflection was terminated after all participants had at least undivided year of follow-up, because the investigators determined that additional follow-up would be unlikely to exhibit a difference between groups. Mean plasma homocysteine evens were virtually identical in the clusters at randomization, and both experienced a following drop in total homocysteine levels; however, the difference was greater in the high-dose vitamin assemblage ranging from 2.0 [micro]mol by L at one month to 23 [micro]mol by means of L at two years. Among patients in the low-dose vitamin dispose 8.1 percent had a returning ischemic stroke compared with 84 percent of patients in the high-dose clump The risk ratio for ischemic knock between the two groups was 10 at pair years. A risk ratio of 09 was plant between the groups for CHD facts and death at two years.

Although no treatment issue was found between the disposes a graded association occurred between baseline homocysteine flats and subsequent homocysteine levels. In the low-dose assign places to a 3 [micro]mol per L lower total homocysteine horizontal was associated with a 10 percent lower risk of thump a 26 percent lower risk of CHD ends and a 16 percent lower risk of death. Decreases in risk in the high-dose cluster were 2 percent for affliction 7 percent for CHD incidents and 7 percent for death, on the contrary these figures were not significant.

In this trial, vitamin therapy had no power on stroke, CHD events, or death. Homocysteine may be a marker for vascular disease risk rather than its cause. It also is possible that the use of grain fortified with folate in the United States attenuated the difference in the amount of folate the brace study groups consumed. Finally, reduc homocysteine plains may be beneficial only in patients with higher homocysteine flushs than the patients included in this study

CAROLINE WELLBERY, MD

Toole JF et al. Lowering homocysteine in patients with ischemic thump to prevent recurrent stroke, myocardial infarction, and death. The Vitamin Intervention for attack Prevention (VISP) randomized controlled trial. JAMA February 4 2004;291:565-75

COPYRIGHT 2004 American Academy of Family Physicians

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