Abstract | BACKGROUND: METHODS: Participants aged 55 years or older with CKD, defined as estimated GFR<60 ml/min and at high cardiovascular risk, were randomly assigned to the combination of folic acid, 2.5 mg, vitamin B6, 50 mg and vitamin B12, 1 mg (n = 307) or placebo (n = 312) daily for 5 years. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction and stroke. RESULTS: Mean baseline plasma homocysteine was 15.9 +/- 7.3 micromol/l in the active treatment group and 15.7 +/- 5.7 micromol/l in placebo group and decreased to 11.9 +/- 3.3 micromol/l (P < 0.001) on active treatment (15.5 +/- 4.5 on placebo). Primary outcome events occurred in 90 participants (29.3%) on active therapy and in 80 (25.6%) on placebo (relative risk, 1.19; 95% confidence interval, 0.88-1.61; P = 0.25). There were no significant treatment benefits on death from cardiovascular causes (1.24; 0.84-1.83), myocardial infarction (1.10; 0.76-1.61) and stroke (1.00; 0.54-1.85). More participants in the active treatment group were hospitalized for heart failure (1.98; 1.21-3.26; P = 0.007) and for unstable angina (1.70; 1.02-2.83; P = 0.04). Incidence of primary outcome increased with decreasing GFR. CONCLUSIONS: Active treatment with B vitamins lowered homocysteine levels in participants with CKD but did not reduce cardiovascular risk.
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Authors | Johannes F E Mann, Patrick Sheridan, Matthew J McQueen, Claes Held, J Malcolm O Arnold, George Fodor, Salim Yusuf, Eva M Lonn, HOPE-2 investigators |
Journal | Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
(Nephrol Dial Transplant)
Vol. 23
Issue 2
Pg. 645-53
(Feb 2008)
ISSN: 1460-2385 [Electronic] England |
PMID | 18003666
(Publication Type: Journal Article, Randomized Controlled Trial)
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Chemical References |
- Homocysteine
- Vitamin B 6
- Folic Acid
- Vitamin B 12
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Topics |
- Aged
- Double-Blind Method
- Drug Therapy, Combination
- Female
- Folic Acid
(therapeutic use)
- Homocysteine
(blood)
- Humans
- Kidney Failure, Chronic
(blood)
- Male
- Vitamin B 12
(therapeutic use)
- Vitamin B 6
(therapeutic use)
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