Normohomocysteinaemia and vitamin-treated hyperhomocysteinaemia are associated with similar risks of cardiovascular events in patients with prematureatherothrombotic cerebrovascular disease - A prospective cohort study

Background: Mild hyperhomocysteinaemia (HHC) is associated with an increase d risk of premature atherothrombotic cerebrovascular disease. We investigat ed the clinical efficacy with regard to the incidence of cardiovascular eve nts of treatment of mild HHC with vitamin B-6 plus relic acid. Methods: We studied 224 consecutive patients with clinically manifest ather othrombotic cerebrovascular disease with onset before the age of 56. Follow -up was obtained in 203 (90.6%) patients. At baseline. 52 (25.6%) were hype r homocysteinaemic after methionine loading and started treatment with vita min B-6 (250 mg) plus folic acid (5 mg); 151 (74.4%) were normohomocysteina emic (reference group). Results: During follow-up (median 57 months:), 31 (20.5%) of the normo- and 11 (21.2%) of the hyperhomocysteinaemic patients had a new cardiovascular event. The crude incidence rate per person-year for any cardiovascular even t was similar in both groups (0.043 [CI, 0.029-0.057] in the normo- vs. 0.0 45 [CI, 0.021-0.069] in the hyperhomocysteinaemic group). Multivariate Cox- regression analyses showed that hypertension and cholesterol levels were as sociated with an increased risk of new cardiovascular events in the total g roup [relative risk [RR] (yes vs. no), 7.4 (3.4-16.0) and RR (pcr 1 mmol/l) , 1.9 (CI, 1.4-2.7)]. The adjusted RR for new cardiovascular events in the hyper- as compared to the normohomocysteinaemic patients was 0.96 (CI, 0.48 -1.92). Conclusion: These data are consistent with a protective effect of treatment with vitamin B-6 plus folic acid in patients with premature atherothrombot ic cerebrovascular disease and post-methionine HHC. (C) 2000 Elsevier Scien ce BN. All rights reserved.