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#1
17.04.2006, 11:21
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Гомоцистеин
Гомоцистеин, конечно, вреден. Однако его снижение не влияет на частоту неблагоприятных исходов. Ни [Ссылки доступны только зарегистрированным пользователям ] ни [Ссылки доступны только зарегистрированным пользователям ]
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#2
18.04.2006, 00:49
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Да, уважаемый Михаил Юрьевич, пожалуй одна из гранд-теорий одного из вероятных механизмов атеросклероза развенчана. гомоцистеин если и влияет на риск, то является немодифицируемым фактором... Думаю, что и все-eще-идущие трайлы закончатся тем же ничем (а народу то вовлекли по всему миру - десятки тыщ!).
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#4
18.04.2006, 16:14
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Цитата:
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#6
19.04.2006, 01:48
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Похоже, что дефекты MTНFR в условиях низкой доступности фолатов в пище могут приводить к гипометилированию ДНК и дестабилизацией генома, что повышает риск экстра-канцерогенеза. Таких всех носителей подвергнуть переписи и пичкать селективно фолиевой будет более тяжелой задачей, нежели просто фортифицировать фолатом питание в пределах страны/континента. Вряд ли это будет иметь отношение к профилактике ИБС.
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#8
29.07.2006, 02:17
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Зарубежная переписка (некоторые аспекты о снижении гомоцистеина и профилактике инсультов - без ссылок и имен, тока аргументы и контра):
The HOPE-2 investigators show a significant, 24 percent reduction in the relative risk of stroke among patients treated with folic acid and vitamins B6 and B12. They downplay this result by relegating a striking figure on the effect of this treatment on stroke to their online Supplementary Appendix. The authors suggest that the result may be spurious, but it agrees closely with the predictions of two large meta-analyses, which suggested that the same change in homocysteine levels achieved in the HOPE-2 trial would result in a reduction in stroke of 19 to 24 percent.1,2 Their view — that a treatment benefit restricted to stroke is biologically implausible — is surprising, given the etiologic differences in coronary disease and stroke. They claim that the findings of the Vitamin Intervention for Stroke Prevention (VISP)3 and NORVIT studies support their conclusion. However, they did not refer to the reanalysis of the VISP trial, which revealed a significant effect on stroke and coronary events.4 The message of the HOPE-2 trial should be one of cautious optimism that B vitamins may protect against stroke. Consistent with this view is a reduction in the rate of death from stroke in the United States and Canada after the introduction of folic acid fortification of food.5 Ответ we do not dismiss the results of the HOPE-2 study in regard to stroke but caution against an overenthusiastic interpretation on the basis of multiple considerations: the overall neutral effect of treatment on the primary outcome and on most secondary and tertiary outcomes (including transient ischemic attacks), the wide confidence intervals around the estimated reduction in the risk of stroke, the apparent increase in the risk of unstable angina, and the neutral results regarding stroke in the VISP and NORVIT trials. The quoted reanalysis of the VISP trial was not prespecified and showed no reduction in stroke (the primary study outcome), death, or events associated with coronary heart disease. At best, the reanalysis showed a borderline effect on a composite cardiovascular outcome (unadjusted outcome, P=0.049; adjusted outcome, P=0.056), which is not a very convincing result to use to justify any clear treatment recommendations. A causal link between recent trends toward a lower rate of death from stroke in the United States and Canada and the fortification of food with folic acid remains speculative, since many other factors may have contributed to the decline. In summary, completed clinical trials do not provide evidence to support the preventive use of B vitamin supplements. Ongoing large trials and the planned meta-analysis of all trials4 will answer remaining relevant clinical questions. NEJM Volume 355:205-211 July 13, 2006 Number 2
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Линейный вид
