B Vitamins May Not Cut Heart Risks
In High-Risk Patients Taking B Vitamin Supplements, Heart Risks Remain
The HOPE 2 researchers noticed that in the vitamin group, fewer patients had strokes but more were hospitalized for unstable angina (chest pain). The stroke findings may have been due to chance, and the reasons for the increase in hospitalizations for unstable angina in the vitamin group aren't clear, the researchers note.
The NORVIT trial also showed an unexpected "trend toward an increased rate of events among patients receiving B vitamins, in particular the combination of folic acid, vitamin B6, and vitamin B12," write Bomaa and colleagues.
Bonaa's team can't rule out the possibility that that trend was due to chance, not the vitamins.
Both studies included a series of lab tests showing that the vitamin takers boosted their levels of the B vitamins. Compliance with the treatments appeared to be good, the studies show.
The HOPE 2 and NORVIT studies show no clear heart benefits with any of the B vitamins that were studied.
"Supplements combining folic acid and vitamins B6 and B12 did not reduce the risk of major cardiovascular events in patients with vascular disease," write Lonn and colleagues for the HOPE 2 study.
"The NORVIT trial demonstrated that intervention with folic acid, with or without high doses of vitamin B6, did not lower the risk of recurrent cardiovascular disease or death after an acute [heart attack]," Bonaa's team writes. "Such therapy may even be harmful after acute [heart attack] or coronary stenting and should therefore not be recommended." Stenting is the use of tiny scaffolds, called stents, to hold blood vessels open.
Remember, both studies only included people at high risk of heart problems. It's not known if the findings apply to other groups of people.
The HOPE 2 and NORVIT studies raise questions, notes Joseph Loscalzo, MD, PhD, in a journal editorial.
Loscalzo works at Harvard Medical School and Boston's Brigham and Women's Hospital. He wasn't involved in the HOPE 2 or NORVIT studies.
Elevated homocysteine levels have been shown in both observational and experimental studies to be associated with more heart disease. But as these important studies show in high-risk patients, lowering homocysteine levels with vitamins does not result in less heart disease. Is homocysteine a marker -- but not a cause -- of heart disease? Does therapy with B vitamins have pros and cons that wash out in high-risk patients? Those are a few of the issues that need more study, Loscalzo writes.
Meanwhile, he states that "although the vitamin doses used, the consequences of folic acid fortification, and the implications of the trend toward lower rates of stroke could all be debated, the consistency among the results leads to the unequivocal conclusion that there is no clinical benefit of the use of folic acid and vitamin B12 [with or without the addition of vitamin B6] in patients with established vascular disease."