Homocysteine-lowering therapy does not prevent recurrent cardiovascular disease after acute myocardial infarction (level 1 [likely reliable] evidence), based on a randomized trial of 3,749 patients ages 30-85 years who received either folic acid 0.8 mg plus vitamin B12 0.4 mg vs. vitamin B6 40 mg vs. combination of both vs. placebo (NEJM 2006 Apr 13;354(15):1578).
In another trial, homocysteine-lowering therapy (folic acid 2.5 mg, vitamin B6 50 mg and vitamin B12 1 mg) was not associated with an overall difference in vascular events (level 2 [mid-level] evidence), based on a randomized trial of 5,522 patients > 55 years old with vascular disease or diabetes (NEJM 2006 Apr 13;354(15):1567).
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