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Hyperhomocysteinemia has been associated with premature atherosclerosis with an increased risk of cardiovascular events.1,–,3 Folate and cyanocobalamin (vitamin B12) are important regulators of the metabolism of homocysteine, and studies have shown an inverse relationship between levels of these factors and levels of homocysteine in the blood.4 5 On the basis of epidemiological studies, clinicians and scientists expected that homocysteine-lowering therapy (HLT) would reduce the incident risk of cardiovascular diseases (including stroke). As a result, HLT has been tested in several randomised clinical trials.6,–,9
In the present study, Lee and colleagues report the results of a meta-analysis including randomised, controlled trials assessing the efficacy of folic acid supplementation in the prevention of stroke. They used a strict inclusion criteria: (1) randomised, controlled study; (2) comparison of folic acid supplementation (with or without vitamins B6 and B12) with inactive or low-dose control; (3) the duration of the intervention was longer than 6 months; and (4) study reporting on the number of stroke events in both active …
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