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Wednesday, October 23, 2002Not surprisingly, the researchers who have invested their life’s work in elevated homcysteine levels and their contribution to heart disease are skeptical, yet their comments to the press underscore frailty of the association of high homocysteine levels with the risk of heart disease: After allowing for other risk factors like high blood pressure and smoking, Dr. Clarke's team found that a person who lowered his homocysteine level 25 percent cut the heart-attack risk 11 percent and the stroke risk 19 percent. "That's still a significant association," said Dr. Paul F. Jacques, chief of nutritional epidemiology for the Human Nutrition Research Center on Aging at Tufts University, part of the Agriculture Department. "It's a modest predictor. But it's all in how you define modest." Is it all that significant to reduce the risk, not the incidence, by 8 percentage points? Not really. By any definition, it’s a modest decrease. Then there’s this: Dr. Stampfer cited a study in the journal of the medical association in August. In it, half of 553 heart patients in Switzerland who had operations to reopen clogged arteries were randomly assigned to receive six months of vitamin B therapy. Those who took the therapy had significantly fewer deaths and heart attacks. In the group that took the vitamins, 2.6 percent had nonfatal heart attacks versus 4.3 percent in the control group. Again, a decrease of what amounts to a little more than one percentage point in incidence isn’t really significant in any sense other than the statistical one. This may seem to be a tempest in a teapot, since homocysteine levels can be altered with diet and with folic acid supplements, but there is a growing movement among cardiologists to use statins, the cholesterol drugs, to treat high homocysteine levels, too. Before that move is made, they’d better make sure there’s a truly clinically significant role for them in heart disease. posted by Sydney on 10/23/2002 09:04:00 AM 0 comments 0 Comments: |
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