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Folic Acid, B Vitamins, and Heart Disease in Women

No evidence shows that supplementation is beneficial, despite lower homocysteine levels.

In observational studies, homocysteine levels are associated with cardiovascular risk. However, randomized trials have not confirmed that homocysteine-lowering therapy (with folic acid and vitamins B₆ and B₁₂) reduces cardiovascular risk, perhaps because the trials were too short to evaluate this outcome. In addition, women have been underrepresented in these trials. To remedy these methodologic deficiencies, researchers conducted a 7-year, randomized, controlled trial that involved 5442 women (age, 40; mean age, 62) with known cardiovascular disease (CVD) or at least three major CVD risk factors.

Intervention subjects received folic acid (2.5 mg), vitamin B₆ (50 mg), and vitamin B₁₂ (1 mg) daily. During 7 years of follow-up, adverse CVD events (myocardial infarction, stroke, coronary revascularization, or cardiac death) occurred in 14.9% of intervention patients and in 14.3% of controls — a nonsignificant difference. In addition, no significant differences were found in analyses of specific outcomes. The mean homocysteine level was lowered by roughly 19% in the intervention group.

Comment: These data are consistent with those of other randomized trials. The study is larger and longer than past trials, and these results appear to resolve the uncertainty about whether such supplementation benefits women, who had been underrepresented previously. Recommending folic acid and B vitamin supplementation to lower risk in patients at high risk for CVD has no basis.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine May 6, 2008

Citation(s):

Albert CM et al. Effect of folic acid and B vitamins on risk of cardiovascular events and total mortality among women at high risk for cardiovascular disease: A randomized trial. JAMA 2008 May 7; 299:2027.

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