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Folic acid and vitamin B12 for CAD
Unfortunately, lowering homocysteine with folic acid and vitamin B12 does not seem to be a benefit to patients with coronary artery disease. In a study from the United Kingdom, more than 12,000 survivors of myocardial infarction were randomized to 2 mg folic acid plus 1 mg vitamin B12 daily vs matching placebo, with the main outcomes being first major vascular event such as coronary event, stroke, or noncoronary revascularization. Folate and vitamin B12 were effective at reducing homocysteine levels by 28%; however, there was no difference in the rate of major vascular events over the 6.7 years of follow-up (25.5% active treatment vs 24.8% placebo; P = 0.28). Individually, there was no effect on major coronary events, stroke, or noncoronary revascularizations, nor was there a survival benefit from active treatment. Interestingly, the authors also looked at incidence of cancer and found no difference in that outcome either. The authors conclude that long-term reductions in blood homocysteine levels with folic acid and vitamin B12 do not have a beneficial effect on vascular or cancer outcomes (JAMA 2010;303:2486-2494).