Cardiology
Homocysteine Lowering in Stable Chronic Vascular Disease: The Heart Outcomes Prevention Evaluation (HOPE)-2 Trial
By American College of Cardiology
Mar 13, 2006, 20:37

High blood levels of the amino acid homocysteine have been linked to an increased risk of cardiovascular disease. Treatment with folic acid, vitamin B6, and vitamin B12 can reduce homocysteine levels by 25 percent to 30 percent, but the clinical benefits of vitamin supplements have been uncertain. The HOPE-2 study has taken steps to determine whether reducing homocysteine levels also reduces the long-term risk of heart attack, stroke or death.

"The idea is very attractive, because homocysteine levels can be easily reduced in most people with inexpensive therapy," said Eva M. Lonn, M.D., M.S.c., F.A.C.C., a professor of medicine and cardiology at McMaster University, Hamilton, Ontario, Canada. "This is the largest trial worldwide completed to date to measure clinical events associated with a reduction of homocysteine levels following treatment with folate and other B vitamins."

Homocysteine is a normal byproduct of the breakdown of methionine, an essential amino acid. Folic acid, vitamin B6, and vitamin B12 are involved in several steps of the complex homocysteine metabolic pathway, ultimately enhancing homocysteine breakdown and excretion.

The HOPE-2 trial involved an international team of researchers from 145 medical centers in 13 countries in North America, South America, and Europe. Investigators enrolled 5,522 patients with established cardiovascular disease or diabetes, randomly assigning them to daily vitamin intake with folic acid, 2.5 mg; vitamin B6, 50 mg; and vitamin B12, 1 mg, or placebo. After two years of vitamin supplements, homocysteine levels were reduced by about 25 percent.

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