title: [Homocysteine, folic acid, group B vitamins and cardiovascular risk].
abstract: Although there is a high degree of proof relating plasma homocysteine levels to cardiovascular risk, the role of homocysteine as a causal cardiovascular risk factor remains controversial. Prospective long-term clinical trials in high cardiovascular risk populations usually show a positive relationship between plasma homocysteine and the degree of cardiovascular risk. However, shorter term studies and/or those carried out in populations with lower cardiovascular risk show either a weaker correlation or no relationship at all. To date no study has shown proof of the reversibility of cardiovascular risk due to hyperhomocysteinaemia; nevertheless, a number of studies using intermediate criteria support the hypothesis of a benefit due to reduction of plasma homocysteine levels. A number of therapeutic trials published with clinical criteria have not shown convincing results in either direction. A number of interventional trials are underway: notably the SUFOLOM 3 trial in France, and the question of a benefit on cardiovascular risk by reducing homocysteine levels should be answered in the next few years. In the meantime, with the exception of homocysteinuria in which therapeutic strategies have shown their efficacy in the reduction of atherothrombotic risk with high levels of proof, the authors do not recommend the treatment of mild hyperhomocysteinaemia in any clinical setting other than "clinical trials" and certain "compassionate" indications such as early and/or recurrent vascular events associated with hyperhomocysteinaemia in the absence of conventional risk factors.
authors.affiliation: Centre de Diagnostic, Unité Hypertension Artérielle, Soins et Prévention Cardiovasculaires. jacques.blacher@htd.ap-hop-paris.fr
authors.forename: J
authors.initials: J
authors.lastname: Blacher
authors.forename: S
authors.initials: S
authors.lastname: Czernichow
authors.forename: M H
authors.initials: MH
authors.lastname: Horrellou
authors.forename: J
authors.initials: J
authors.lastname: Conad
authors.forename: P
authors.initials: P
authors.lastname: David
authors.forename: B
authors.initials: B
authors.lastname: Chadefaux-Vekemans
authors.forename: A
authors.initials: A
authors.lastname: Ankria
authors.forename: P
authors.initials: P
authors.lastname: Galan
authors.forename: S
authors.initials: S
authors.lastname: Hercberg
authors.forename: P
authors.initials: P
authors.lastname: Ducimetière
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D005492:Folic Acid / Q000627:therapeutic use; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications* / Q000628:therapy; D012307:Risk Factors; D014803:Vitamin B Complex / Q000627:therapeutic use
chemical_list: D006397:Hematinics; D014803:Vitamin B Complex; D005492:Folic Acid