Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Int J Clin Pract. 2010 Jan;64(2):208-15. doi: 10.1111/j.1742-1241.2009.02207.x. Epub 2009 Nov 13.
To evaluate the effects of homocysteine lowering intervention on the risk of cardiocerebrovascular events and all-cause mortality in randomised controlled trials among people with preexisting cardiocerebrovascular or renal disease.
Studies were retrieved by searching MEDLINE and OVID (from January 1966 to December 2008) using the following keywords: homocysteine, hyperhomocysteinaemia, cardiovascular disease, coronary disease, cerebrovascular disease, B vitamins, folic acid, randomised controlled trial. References of all retrieved articles were also searched. Randomised controlled trials which compared folic acid or plus B vitamins supplementation with either placebo or usual care were evaluated with cardiocerebrovascular disease events or all-cause mortality reported as an end-point. Data on study design, characteristics of participants, changes in homocysteine levels, and cardiocerebrovascular events and all-cause mortality were independently abstracted by two investigators using a standardised protocol.
Seventeen trials involving 39,107 patients with preexisting cardiocerebrovascular or renal disease were included. Results of meta-analyses showed that no significant differences were identified between the intervention group and the control group. The overall relative risks (95% confidence intervals) of outcomes for patients treated with folic acid or plus B vitamins supplementation compared with controls were 1.01 (0.97-1.05) for cardiovascular events, 1.01 (0.94-1.07) for coronary heart disease, 0.94 (0.85-1.04) for stroke and 1.00 (0.95-1.05) for all-cause mortality. In the exclusion of low-quality trials and seven trials in grain fortification countries respectively, sensitivity analyses did not change the overall results.
There is no sufficient evidence to show that homocysteine lowering intervention can reduce the risk of cardiocerebrovascular diseases or all-cause mortality among people with preexisting vascular disease. Folic acid supplementation should not be recommended for the secondary prevention of cardiocerebrovascular diseases. More evidence from large-scale randomised controlled trials is needed to confirm this.
评估降低同型半胱氨酸干预对伴有既往心脑血管或肾脏疾病的人群中心脑血管事件和全因死亡率的风险。
通过检索 MEDLINE 和 OVID（1966 年 1 月至 2008 年 12 月），使用以下关键词检索文献：同型半胱氨酸、高同型半胱氨酸血症、心血管疾病、冠心病、脑血管疾病、B 族维生素、叶酸、随机对照试验。还检索了所有检索到的文章的参考文献。评估了比较叶酸或 B 族维生素联合治疗与安慰剂或常规治疗的随机对照试验，以报道的心血管疾病事件或全因死亡率为终点。两名研究者使用标准化方案独立提取研究设计、参与者特征、同型半胱氨酸水平变化以及心脑血管事件和全因死亡率的数据。
纳入了 17 项涉及 39107 例伴有既往心脑血管或肾脏疾病的患者的试验。荟萃分析结果显示，干预组与对照组之间未发现显著差异。与对照组相比，接受叶酸或 B 族维生素联合治疗的患者的心血管事件、冠心病、中风和全因死亡率的总体相对风险（95%置信区间）分别为 1.01（0.97-1.05）、1.01（0.94-1.07）、0.94（0.85-1.04）和 1.00（0.95-1.05）。分别排除低质量试验和谷物强化国家的 7 项试验后，敏感性分析未改变总体结果。
没有充分的证据表明降低同型半胱氨酸干预可以降低伴有既往血管疾病的人群中心血管疾病或全因死亡率的风险。不推荐叶酸补充用于心脑血管疾病的二级预防。需要更多来自大规模随机对照试验的证据来证实这一点。
