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Review
. 2006 Nov 25;333(7578):1114-7.
doi: 10.1136/bmj.39000.486701.68.

Folic acid, homocysteine, and cardiovascular disease: judging causality in the face of inconclusive trial evidence

David S Wald  1 , Nicholas J Wald, Joan K Morris, Malcolm Law
Affiliations
Review

Folic acid, homocysteine, and cardiovascular disease: judging causality in the face of inconclusive trial evidence

David S Wald et al. BMJ. .

Abstract

Increasing intake of folic acid would be a relatively cheap and simple way of reducing heart disease, if it works. Can we draw a definitive conclusion from the current evidence?

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Conflict of interest statement

Competing interests: ML, NJW, and DSW have interests in a combined pill (polypill) to simultaneously reduce four cardiovascular risk factors including homocysteine. NJW and ML have patents (granted and pending) on the formulation of the polypill.

Figures

None
Fig 1 Dose-response relation between odds ratio of ischaemic heart disease and stroke and difference in homocysteine concentrations between TT and CC homozygotes
None
Fig 2 Meta-analyses of the randomised trials of lowering homocysteine concentrations on ischaemic heart disease and stroke events. In some cases the relative risk estimates in the figure are not identical to those published in the original papers because they are based on coronary deaths and non-fatal myocardial infarction only, without including endpoints such as angioplasty and coronary artery bypass surgery
See this image and copyright information in PMC

References

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    1. Homocysteine Studies Collaboration. Homocysteine and the risk of ischemic heart disease and stroke. JAMA 2002;288:2015-22. - PubMed
    1. Mudd SH, Skovby F, Levy H, Pettigrew KD, Wilcken B, Pyeritz RE, et al. The natural history of homocystinuria due to cystathionine β synthase deficiency. Am J Hum Genet 1985;37:1-31. - PMC - PubMed
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