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首页> 外文期刊>Cardiovascular therapeutics >Why Do Homocysteine-Lowering B Vitamin and Antioxidant E Vitamin Supplementations Appear To Be Ineffective in the Prevention of Cardiovascular Diseases?
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Why Do Homocysteine-Lowering B Vitamin and Antioxidant E Vitamin Supplementations Appear To Be Ineffective in the Prevention of Cardiovascular Diseases?

机译：为什么降低同型半胱氨酸B族维生素和抗氧化剂E族维生素的补充剂在预防心血管疾病方面似乎无效？

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摘要

Homocysteine has been established as a serious, independent risk factor for atherosclerosis. An elevated plasma homocysteine concentration is accompanied by increased cardiovascular risk; therefore, it can be assumed that lowering the plasma homocysteine level results in a decreased risk. Vitamin B complex (folic acid, and vitamins B6 and B12) substitution therapy decreases the plasma homocysteine level, inhibits oxidative stress, and ameliorates some biochemical and clinical parameters that indicate the progression of atherosclerosis. Vitamin E administration may also reduce atherogenesis through its antioxidant effect. The effectiveness of B and E vitamin substitution in decreasing cardiovascular risk has been suggested by cohort as well as prospective and retrospective studies undertaken during the last two decades. On the other hand, recent large, randomized clinical trials did not substantiate a beneficial effect of homocysteine-lowering B vitamin supplementation or vitamin E antioxidant therapies in reducing cardiovascular risk in humans. We analyzed eight B vitamin and four E vitamin trials from a critical point of view, and in this article we reviewed and commented on their results and focused on the contradictions found in them. We showed that the possible factors implicated in the failure of vitamin therapies included inappropriate designs. The protocols neglected an essential fact: that the impact of some confounding factors, such as concomitant use of statins, acetylsalicylic acid, folic acid, and other drugs, might have led to bias and an inappropriate interpretation of the data. The cardiovascular protective and preventive effects of statins and aspirin might have reduced or abolished the possibility of observing a difference in the number of events between the vitamin and placebo groups for the clinical endpoints. We concluded that the vitamin preventive effect on cardiovascular disease may not be rejected in reference to the negative trial evidence.
机译：同型半胱氨酸已被确定为动脉粥样硬化的严重，独立危险因素。血浆同型半胱氨酸浓度升高会增加心血管风险;因此，可以假设降低血浆高半胱氨酸水平可降低风险。维生素B复合物（叶酸，以及维生素B6和B12）替代疗法可降低血浆同型半胱氨酸水平，抑制氧化应激并改善某些指示动脉粥样硬化进展的生化和临床参数。服用维生素E还可以通过其抗氧化作用减少动脉粥样硬化。最近二十年来进行的队列研究以及前瞻性和回顾性研究表明，B和E维生素替代物在降低心血管疾病风险方面的有效性。另一方面，最近的一项大型随机临床试验并未证实降低同型半胱氨酸的维生素B补充剂或维生素E的抗氧化剂疗法对降低人类心血管疾病的有益作用。我们从一个关键的角度分析了八项B族维生素和四项E族维生素的试验，在本文中，我们对它们的结果进行了回顾和评论，并着重研究了它们之间的矛盾。我们发现，与维生素治疗失败有关的可能因素包括设计不当。该协议忽略了一个基本事实：某些混杂因素的影响，例如同时使用他汀类药物，乙酰水杨酸，叶酸和其他药物，可能导致偏见和对数据的不恰当解释。他汀类药物和阿司匹林的心血管保护作用和预防作用可能减少或消除了观察维生素和安慰剂组临床终点事件数目差异的可能性。我们得出的结论是，参考阴性试验证据不能否认维生素对心血管疾病的预防作用。

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