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Risk factors

Lowering homocysteine levels may have no 'FAVORITable' effect on cardiovascular outcomes

Nature Reviews Nephrology volume 7, page 304 (2011)Cite this article

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Kidney transplant recipients often display an elevated plasma level of homocysteine, which has been shown to increase the risk of cardiovascular disease (CVD). Whether hyperhomocysteinemia is itself a cause of clinical events, or is instead a surrogate marker for CVD, is unknown. The FAVORIT trial assessed whether a reduction in total homocysteine levels using a vitamin B supplement containing folic acid would reduce the risk of CVD outcomes in kidney transplant recipients.

The group receiving the high-dose supplement with folic acid showed a significantly greater reduction in homocysteine levels than did the low-dose group (mean 4-year change from baseline −4.6 μmol/l versus −0.2 μmol/l). However, this change did not translate into improved outcomes as no differences were seen between groups in the occurrence of CVD outcomes, all-cause mortality, or dialysis-dependent kidney failure. A similar number of patients in each group were hospitalized, and side effects did not differ between the groups. “Our findings confirm that there is no role for the screening and treatment of hyperhomocysteinemia in chronic kidney disease,” says investigator Andrew Bostom. “Observational analyses of the FAVORIT trial database will be useful for generating new hypotheses regarding other potential risk factors for cardiorenal outcomes in transplant patients with chronic kidney disease.”

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ORIGINAL RESEARCH PAPER

  1. Bostom, A. G. et al. Homocysteine-lowering and cardiovascular disease outcomes in kidney transplant recipients: primary results from the Folic Acid for Vascular Outcome Reduction in Transplantation trial. Circulation doi:10.1161/CIRCULATIONAHA.110.000588

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  1. Helene Myrvang
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Myrvang, H. Lowering homocysteine levels may have no 'FAVORITable' effect on cardiovascular outcomes. Nat Rev Nephrol 7, 304 (2011). https://doi.org/10.1038/nrneph.2011.45

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  • DOI: https://doi.org/10.1038/nrneph.2011.45

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