TY - JOUR T1 - Lowering homocysteine with folic acid and B vitamins did not prevent vascular events after myocardial infarction JF - Evidence Based Medicine JO - Evid Based Med SP - 105 LP - 105 DO - 10.1136/ebm.11.4.105 VL - 11 IS - 4 A2 - , Y1 - 2006/08/01 UR - http://ebm.bmj.com/content/11/4/105.abstract N2 - Bønaa KH, Njølstad I, Ueland PM, et al. Homocysteine lowering and cardiovascular events after acute myocardial infarction. N Engl J Med 2006;354:1578–88.OpenUrlCrossRefPubMedWeb of Science 
 
 Q In patients with acute myocardial infarction (MI), does lowering plasma homocysteine concentrations with folic acid plus vitamin B12 or vitamin B6 reduce risk of major vascular events? Clinical impact ratings GP/FP/Primary care ★★★★★★★ IM/Ambulatory care ★★★★★★☆ Cardiology ★★★★★★☆ Design randomised, 2 × 2 factorial design, placebo controlled trial (Norwegian Vitamin [NORVIT] trial). Allocation concealed.* Blinding blinded (clinicians, patients, data collectors, and outcome assessors).* Follow up period 2.0–3.5 years (median 3.3 y). Setting 35 hospitals in Norway. Patients 3749 patients 30–85 years of age (mean age 63 y, 74% men) with acute MI in the previous 7 days. Exclusion criteria included life expectancy <4 years. Intervention a combined capsule with 0.8 mg folic acid, 40 mg vitamin B6, and 0.4 mg vitamin B12 (n = 937); 0.8 mg folic acid and 0.4 mg vitamin B12 (n = 935); 40 mg vitamin B6 (n = 934); or placebo (n = 943), taken once daily. Outcomes a composite end point of MI, stroke, or sudden death from coronary heart disease. Secondary outcomes included MI, stroke, hospital admission for unstable angina, and death from any cause. Patient follow up 99% (intention to treat analysis). Mean baseline homocysteine concentrations were 12.9–13.3 µmol/l (1.7–1.8 mg/l). Mean homocysteine concentration … ER -