Homocysteine lowering interventions for preventing cardiovascular events
Cardiovascular disease is the number one cause of death worldwide. The most common causes of its morbidity and mortality are ischaemic heart disease, stroke and congestive heart failure. Many people with cardiovascular diseases may be asymptomatic, and might have high risk for developing a myocardial infarction, angina pectoris, stroke (ischaemic, haemorrhagic or both). 'Emergent or new risk factors' for cardiovascular disease have been recently added to the established risk factors (diabetes mellitus, high blood pressure, active smoker, adverse blood lipid profile). One of these risk factors is an elevated circulating total homocysteine (tHcy) levels. Homocysteine is an amino acid, and its levels in blood are influenced by blood levels of B-complex vitamins: cyanocobalamin (B12), folic acid (B9) and pyridoxine (B6). High tHcy levels are associated with an increased risk for atherosclerotic diseases. Hence, it has been suggested that B vitamins supplementation might reduce the risk of myocardial infarction, stroke, angina pectoris. Preventive strategies might include healthy people with low or high risk for developing cardiovascular disease (primary prevention) and people with an established cardiovascular disease (secondary prevention). In this review we included eight randomised controlled trials equivalent to 24,210 participants. We found no evidence that homocysteine-lowering interventions, in the form of supplements of vitamins B6, B9 or B12 given alone or in combination, at any dosage compared with placebo or standard care, prevents myocardial infarction, stroke, or reduces total mortality in participants at risk or with established cardiovascular disease.
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Available from: Frank H Comhaire
- "Vitamins B The association of vitamins B6 (pyridoxin), B9 (folic acid) and B12 (cyanocobalamine) reduces the production of homocysteine (Gariballa et al., 2012) and DNA methylation , but there are contradictory reports regarding the protection against cognitive decline (De Jager et al., 2012; Nachum-Biala & Troen, 2012), vascular disease (Saposnik et al., 2009; Marti-Carvajal et al., 2015) or death (Towfighi et al., 2014). It has been documented that the regular intake of these vitamins B prevents brain shrinkage, and the resulting dementia, among persons with a high homocysteine concentration in blood (Douaud et al., 2013), whereas folate intake below the recommended daily allowance was associated with increased risk of cognitive impairment (Agnew-Blais et al., 2015). "
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ABSTRACT: The long-term intake of a judiciously composed nutriceutical containing low-dose vitamins, antioxidants, minerals and particular herbal preparations seems justified for older persons who take medication, or who consume an unbalanced diet, or who are exposed to environmental toxins. Recent reports suggest these nutriceuticals may delay age-related diseases and the occurrence of cancer, and reduce mortality in apparently healthy ageing men. Food supplementation with a nutriceutical that was formulated particularly for ageing men should result in an increase of at least one quality-adjusted life year and may lower the financial and social burden of disease in elderly people.
Andrologia 09/2015; DOI:10.1111/and.12489 · 1.63 Impact Factor
Available from: Huazheng Liang
- "It has been shown that the nutritional status of stroke patients is closely related to their long term clinical outcome . Though a large number of studies have investigated the effect of specific nutrients on the recurrence of stroke such as vitamin B, folic acid ( , antioxidants   , and fat    ), none have shown significant improvements in mortality and recurrence of stroke. There is no evidence to support the timing or choice of nutritional method which should be used in stroke patients. "
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ABSTRACT: We hypothesized that early enteral nutritional support would improve the short term prognosis of acute stroke patients with dysphagia, demonstrated by lower malnutrition rates, lower complication rates, and lower National Institutes of Health Stroke Scale (NIHSS) scores at 90days post stroke. Nutrition support is an essential element in the care of stroke patients and many studies have investigated the effect of specific nutritional elements on stroke patients. However, few studies have looked at the impact of complete enteral nutrition on Chinese patients with acute stroke. To investigate this, we conducted a randomized controlled trial of 146 patients with acute stroke and dysphagia, among whom 75 were supported with nasogastric nutrition and 71 received family managed nutrition after randomization. Nutritional status, nosocomial infection and mortality rates were recorded on day 21 of hospitalization. Neurological deficits were evaluated by the NIHSS activities of daily living Barthel index (ADLBI) and the modified Rankin scale (mRS) and compared between the two groups. We found that the nasogastric nutrition group had a better nutritional status and reduced nosocomial infection and mortality rates after 21days compared with patients in the family managed nutrition group. In addition, the nasogastric nutrition group showed a lower score on the NIHSS than the control group. However, the differences in the scores of the ADLBI and the 90day mRS between the groups were not significant. Taken together, the present study shows that early enteral nutrition support improves the short term prognosis of acute stroke patients with dysphagia.
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Journal of Clinical Neuroscience 07/2015; 22(9). DOI:10.1016/j.jocn.2015.03.028 · 1.38 Impact Factor
Available from: PubMed Central
- "Subsequently, numerous cross-sectional and case control studies have demonstrated a clear association between total serum homocysteine and the presence of coronary, carotid, and peripheral vascular disease23456. However, a systemic review of 12 randomized controlled trials involving 47,429 participants showed that homocysteine-lowering interventions compared with placebo did not significantly affect non-fatal or fatal myocardial infarction, stroke or death by any cause313233. Clinical benefit of homocysteine lowering therapy is very controversial topics. "
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ABSTRACT: Hyperhomocystemia has been reported to be associated with cardiovascular disease, especially stroke. The resistive index (RI) estimated by carotid ultrasound is an established variable for estimating the risk of cerebral infarction. The aim of this study was to evaluate the relationship between homocysteine concentration and carotid RI, a marker of cerebral vascular resistance in essential hypertensive patients. We measured serum total homocysteine and carotid RI in 261 patients. Multiple linear regression analysis was used to determine the association of homocysteine with carotid RI and intima media thickness (IMT). Age, sex, BMI, systolic blood pressure (SBP), homocysteine, total cholesterol, high density lipoprotein-cholesterol (HDL-C), uric acid, CRP, HbA1c, estimated glomerular filtration rate, and use of antihypertensive agents were included as independent variables. Age, sex, use of antihypertensive agents, HDL-C and homocysteine levels were shown to be significant predictors of carotid RI, but not IMT. Multiple regression analysis in men older than 65 years showed homocysteine and SBP were associated significantly with carotid RI. In elderly male patients, homocysteine was the strongest predictor of carotid RI (B = 0.0068, CI = 0.0017-0.0120, P = 0.011) in the multivariate model. In conclusion, hyperhomocysteinemia is associated with carotid RI, a surrogate marker of cerebral vascular resistance, especially in elderly men.
Scientific Reports 07/2014; 4:5663. DOI:10.1038/srep05663 · 5.58 Impact Factor
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