用vit b 降低homocystein 無法增進MI後病人的預後

Homocysteine-Lowering with B Vitamins After Angiography Shows No Benefit

Homocysteine-lowering therapy after coronary angiography doesn't improve patient outcomes, JAMA reports.

Nearly 3100 adults were randomized to begin one of four daily treatments after undergoing angiography for suspected coronary artery disease or aortic valve stenosis:

* Folic acid plus vitamins B6 and B12
* Folic acid plus vitamin B12
* Vitamin B6
* Placebo

Homocysteine levels dropped significantly in the folic acid/vitamin B12 groups but remained unchanged in the other two groups. However, during roughly 3 years' follow-up, incidence of the primary composite endpoint (mortality, MI, hospitalization for unstable angina, thromboembolic stroke) did not differ between folic acid/B12 users and nonusers.

In Journal Watch General Medicine, Allan Brett notes that four other large trials have produced similar results. He concludes: "In my experience, some clinicians continue to prescribe brand-name B-vitamin supplements to [cardiac patients], at a cost of hundreds of dollars annually. This practice can no longer be justified."
LINK(S):

JAMA article (Free)

Journal Watch General Medicine summary (Free)

Published in Physician's First Watch August 20, 2008

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