Folic acid, homocysteine and cardiovascular disease

Folic acid, homocysteine and cardiovascular diseaseBMJ 2006, 333, 114-7

Wald and his colleagues have published a meta analysis of Folic acid, homocysteine and cardiovascular disease, judging causality in the face of inconclusive trial evidence.
Meta ananysis of cohort studies show significant positive associations betwen serum homocysteine concentrations and ischaemic heart events and stroke. A 3 umol decrease in serum homocysteine ( achievable with 0.8 mg/day folic acid lowers the risk of myocardial infarct by 15% and stroke by 24 %.
Moderate raised homocysteine occurs as a result of a mutaiton in the methylenetetrofolate reductase gene.
The size of studies are small and there may be a publication bias, benefit publish , don’t benefit, forget it.
However Wald and his colleagues looked at the meta analysis studies, genetic polymorphism studies and randomised trials and tok the view that the evidence was now sufficient to justify lowering the serum homocysteine concnetration.

Martin Eastwood
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