Homocysteine lowering and cardiovascular events after acute myocardial infarction

Introduction: Overwhelming evidence has shown that statin therapy is beneficial in reducing cardiovascular events and even cardiovascular mortality in a wide spectrum of patients [1]. Unfortunately, statin therapy only reduces cardiovascular events by approximately 25% or 40%, and so many patients still experience cardiovascular events [2]. Lowering serum homocysteine levels has been suggested as one of the strategies for possibly reducing additional cardiovascular risk. Epidemiologic studies of serum homocysteine levels have shown evidence of a positive association between homocysteine levels and the risk of occlusive vascular disease [2], but until recently, few randomized controlled clinical trials have demonstrated the effectiveness of lowering homocysteine levels on reducing cardiovascular risk. Plasma total homocysteine can be lowered with the B vitamins folic acid and B12, and so the Norwegian Vitamin (NORVIT) trial was conducted.