Homocysteine lowering interventions for preventing cardiovascular events.
Homocysteine lowering interventions for preventing cardiovascular events.
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DOI：
10.1002/14651858.cd006612.pub2
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发表时间：
2009-10-07
影响因子：
8.4
通讯作者：
Salanti, Georgia
中科院分区：
文献类型：
--
作者：
Marti-Carvajal, Arturo J.;Sola, Ivan;Lathyris, Dimitrios;Salanti, Georgia
心血管疾病，如冠状动脉疾病、中风和充血性心力衰竭，是全世界死亡的主要原因。一个假定的风险因素是循环总同型半胱氨酸（tHcy）水平升高，主要受氰钴胺（维生素B12）、叶酸（维生素B 9）和吡哆醇（维生素B6）血液水平的影响。关于tHcy与心血管疾病风险之间的关联强度尚不确定。评估降低同型半胱氨酸干预（HLI）在有或无既存心血管疾病的人群中的临床有效性。我们在科克伦图书馆（2008年第3期）、MEDLINE（1950年至2008年8月）、EMBASE（1988年至2008年8月）和LILACS（1982年至2008年9月2日）上检索了科克伦对照试验中心注册库（CENTRAL）。我们还检索了Allied and Complementary Medicine（AMED; 1985年至2008年8月）、ISI Web of Science（1993年至2008年8月）和科克伦卒中组专业注册库（2007年4月）。我们手工检索了相关期刊和纳入论文的参考文献列表。我们还联系了该领域的研究人员。搜索中没有语言限制。我们纳入了评估HLI预防心血管事件效果的随机临床试验（RCT），随访期为1年或更长。我们认为心肌梗死和卒中是主要结局。我们排除了终末期肾病患者的研究。我们独立进行研究选择、偏倚风险评估和数据提取。我们估计了二分结局的相对风险（RR）。我们使用I2测量统计异质性。我们使用随机效应模型来综合研究结果。我们纳入了8项随机对照试验，涉及24，210名参与者，一般而言偏倚风险较低。HLI不能降低非致死性或致死性心肌梗死、卒中或任何原因死亡的风险（合并RR 1.03，95% CI 0.94 - 1.13，I2 = 0%;合并RR 0.89，95% CI 0.73 - 1.08，I2 = 15%）;合并RR 1.00（95% CI 0.92 - 1.09，I2：0%）。现有已发表试验的结果表明，没有证据支持使用HLI预防心血管事件。
Cardiovascular disease such as coronary artery disease, stroke and congestive heart failure, is a leading cause of death worldwide. A postulated risk factor is elevated circulating total homocysteine (tHcy) levels which is influenced mainly by blood levels of cyanocobalamin (vitamin B12), folic acid (vitamin B9) and pyridoxine (vitamin B6). There is uncertainty regarding the strength of association between tHcy and the risk of cardiovascular disease. To assess the clinical effectiveness of homocysteine-lowering interventions (HLI) in people with or without pre-existing cardiovascular disease. We searched The Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (issue 3 2008), MEDLINE (1950 to August 2008), EMBASE (1988 to August 2008), and LILACS (1982 to September 2, 2008). We also searched in Allied and Complementary Medicine (AMED; 1985 to August 2008), ISI Web of Science (1993 to August 2008), and the Cochrane Stroke Group Specialised Register (April 2007). We hand searched pertinent journals and the reference lists of included papers. We also contacted researchers in the field. There was no language restriction in the search. We included randomised clinical trials (RCTs) assessing the effects of HLI for preventing cardiovascular events with a follow-up period of 1 year or longer. We considered myocardial infarction and stroke as the primary outcomes. We excluded studies in patients with end-stage renal disease. We independently performed study selection, risk of bias assessment and data extraction. We estimated relative risks (RR) for dichotomous outcomes. We measured statistical heterogeneity using I2. We used a random-effects model to synthesise the findings. We included eight RCTs involving 24,210 participants with a low risk of bias in general terms. HLI did not reduce the risk of non-fatal or fatal myocardial infarction, stroke, or death by any cause (pooled RR 1.03, 95% CI 0.94 to 1.13, I2 = 0%; pooled RR 0.89, 95% CI 0.73 to 1.08, I2 = 15%); and pooled RR 1.00 (95% CI 0.92 to 1.09, I2: 0%), respectively. Results from available published trials suggest that there is no evidence to support the use of HLI to prevent cardiovascular events.