Joel G. Ray, MD, MSc; Clive Kearon, MD, PhD; Qilong Yi, PhD; Patrick Sheridan, MSc; Eva Lonn, MD, MSc; Heart Outcomes Prevention Evaluation 2 (HOPE-2) Investigators*
Ray JG, Kearon C, Yi Q, Sheridan P, Lonn E, Heart Outcomes Prevention Evaluation 2 (HOPE-2) Investigators*. Homocysteine-Lowering Therapy and Risk for Venous Thromboembolism: A Randomized Trial. Ann Intern Med. 2007;146:761-767. doi: 10.7326/0003-4819-146-11-200706050-00157
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Published: Ann Intern Med. 2007;146(11):761-767.
In observational studies, elevated plasma homocysteine levels were associated with venous thromboembolism. A multicenter trial of folic acid and B vitamins to reduce cardiovascular events investigated the effect of homocysteine lowering on venous thromboembolism.
In this trial, 5522 adults were randomly assigned to receive placebo, or folic acid and vitamins B6 and B12 daily for 5 years. Vitamin therapy decreased homocysteine levels, but the incidence of venous thromboembolism was the same in both groups, even in participants with the highest levels of homocysteine.
Venous thromboembolism events were not centrally adjudicated.
Decreasing homocysteine levels with supplements containing folic acid and vitamins B6 and B12 does not reduce the incidence of venous thromboembolism.
*Limited to the 3306 participants for whom homocysteine was measured at baseline. †Homocysteine level >13.8 µmol/L.
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