Combined B-vitamin supplementation on homocysteine and vascular outcomes in coronary heart disease: a meta-analysis.
Liping Guo, Xiangfen Shi, Gaobiao Wang et al.
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In 30 seconds
This random-effects meta-analysis assessed combined folic acid, vitamin B6, and vitamin B12 supplementation in people with coronary heart disease (CHD). It included 13 studies and 14,539 participants, comparing combined supplementation with control regimens. Supplementation reduced serum homocysteine (mean difference: -2.36; 95% CI: -3.09 to -1.62; p < 0.01) and was associated with less vascular restenosis (risk ratio: 0.65; 95% CI: 0.44-0.95; p < 0.05). No significant difference was found in major cardiovascular events or cardiovascular-related mortality, leaving broader clinical benefit uncertain.
Key findings
- Combined B vitamins reduced serum homocysteine versus single-nutrient regimens (mean difference: -2.36; 95% CI: -3.09 to -1.62; p < 0.01).
- Vascular restenosis was less frequent with supplementation (risk ratio: 0.65; 95% CI: 0.44-0.95; p < 0.05).
- Major cardiovascular events did not differ significantly between groups (p = 0.78).
- Cardiovascular-related mortality was not significantly reduced (risk ratio: 0.96; 95% CI: 0.85-1.07; p = 0.44).
Why it matters
The findings distinguish biochemical effects from patient-important outcomes: homocysteine lowering and reduced restenosis did not translate into demonstrated reductions in major cardiovascular events or cardiovascular mortality. This helps frame the evidence for combined B-vitamin supplementation in CHD and cautions against assuming that improvement in a risk marker establishes broader cardiovascular benefit.
What to keep in mind
The abstract does not report study-level design details or assess variation in the included studies, limiting appraisal of the pooled estimates.