Startseite B vitamin therapy for homocysteine: renal function and vitamin B12 determine cardiovascular outcomes
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B vitamin therapy for homocysteine: renal function and vitamin B12 determine cardiovascular outcomes

  • John David Spence EMAIL logo
Veröffentlicht/Copyright: 1. März 2013
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Abstract

Therapy to lower homocysteine with B vitamins does reduce the risk of stroke, if not myocardial infarction. The apparent lack of efficacy of vitamin therapy in most of the large clinical trials was probably determined by the failure to take account of the metabolic deficiency of vitamin B12, which is very common and often missed, and by the failure to take account of impaired renal function. Metabolic B12 deficiency is present in 20% of people over 65 years of age, and in 30% of vascular patients above 70 years, so higher doses of B12 are needed in elderly patients. However, high-dose cyanocobalamin leads to accumulation of cyanide in patients with renal failure. B vitamin therapy is beneficial in patients with good renal function, but harmful in patients with significantly impaired renal function (a glomerular filtration rate <50). It seems likely that in patients with renal impairment, methylcobalamin should be used instead cyanocobalamin.


Corresponding author: Dr. John David Spence, Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, 1400 Western Road, London, ON, Canada N6G 2V2, Phone: +1 519 9315731, Fax: +1 519 9315737

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Received: 2012-7-17
Accepted: 2012-9-27
Published Online: 2013-03-01
Published in Print: 2013-03-01

©2013 by Walter de Gruyter Berlin Boston

Artikel in diesem Heft

  1. Masthead
  2. Masthead
  3. Editorial
  4. Special issue on advances and controversies in B vitamins and choline
  5. Reviews
  6. B-Vitamin dependent methionine metabolism and alcoholic liver disease
  7. Metabolic crosstalk between choline/1-carbon metabolism and energy homeostasis
  8. Proteomics of vitamin B12 processing
  9. Unexpected high plasma cobalamin/Proposal for a diagnostic strategy
  10. Clinical recognition and aspects of the cerebral folate deficiency syndromes
  11. Choline-containing phospholipids: relevance to brain functional pathways
  12. The ‘golden age’ of DNA methylation in neurodegenerative diseases
  13. Mechanisms of the beneficial effects of vitamin B6 and pyridoxal 5-phosphate on cardiac performance in ischemic heart disease
  14. The diagnostic utility of folate receptor autoantibodies in blood
  15. Red cell or serum folate: what to do in clinical practice?
  16. Formate: an essential metabolite, a biomarker, or more?
  17. The role of homocysteine in bone remodeling
  18. Mini Reviews
  19. Neuroprotective actions of perinatal choline nutrition
  20. Normal prions as a new target of cobalamin (vitamin B12) in rat central nervous system
  21. Molecular mechanisms underlying the potentially adverse effects of folate
  22. Betaine homocysteine methyltransferase (BHMT)-dependent remethylation pathway in human healthy and tumoral liver
  23. Hydrogen sulfide as an oxygen sensor
  24. Opinion Paper
  25. B vitamin therapy for homocysteine: renal function and vitamin B12 determine cardiovascular outcomes
  26. Research Articles
  27. One year B and D vitamins supplementation improves metabolic bone markers
  28. Effect of 1 year B and D vitamin supplementation on LINE-1 repetitive element methylation in older subjects
  29. Aqueous humor glycation marker and plasma homocysteine in macular degeneration
  30. Homocysteine plasma levels in patients treated with antiepileptic drugs depend on folate and vitamin B12 serum levels, but not on genetic variants of homocysteine metabolism
  31. Trends in clinical laboratory homocysteine testing from 1997 to 2010: the impact of evidence on clinical practice at a single institution
  32. Three family members with elevated plasma cobalamin, transcobalamin and soluble transcobalamin receptor (sCD320)
  33. Plasma choline and betaine correlate with serum folate, plasma S-adenosyl-methionine and S-adenosyl-homocysteine in healthy volunteers
  34. Plasma homocysteine and vitamin B12 serum levels, red blood cell folate concentrations, C677T methylenetetrahydrofolate reductase gene mutation and risk of recurrent miscarriage: a case-control study in Spain
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