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Review: high levels of homocysteine are associated with an increased risk for cardiovascular disease

Data sources
Epidemiological studies (randomised controlled trials and cohort, case control, and cross sectional studies) were identified by searching Medline (1965 to January 1999) using the terms coronary heart disease, cerebrovascular disease, peripheral vascular disease, and atherosclerosis combined with the terms homocysteine, B-6, B-12, and folic acid. Bibliographies of relevant studies were also checked.

Study selection
All prospective and retrospective studies were included if they evaluated >150 patients who were considered to be cases, if they were published after 1995, and if they measured the association between homocysteine levels and cardiovascular disease or the intake of folic acid or vitamins B-6 and B-12.

Data extraction
Data were extracted on study design and setting; patient selection criteria, characteristics, and outcomes; homocysteine levels; and use of folic acid and vitamins B-6 and B-12. Data were not combined because of study dissimilarities.

Main results
Cross sectional and case-control studies showed an association between plasma homocysteine levels and carotid disease (5 studies), . . . [Full text of this article]

Bernard A Cooper, MD

Stanford University San Jose, California, USA