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QUESTIONS: Are high levels of homocysteine associated with an increased risk for cardiovascular disease? Can levels of homocysteine be decreased by folic acid, either alone or combined with vitamin B-6 or B-12?
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.
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 …