Er det en assosiasjon mellom homocystein og kardiovaskulæ sykdom (CVD), og i tilfelle er det en markør eller risikofaktor? Hvordan kan en eventuell assosiasjon nyttiggjøres i en klinisk hverdag? : En systematisk oversikt

Abstract

Context It has been suggested that total blood homocysteine concentrations are associated with the risk of cardiovascular diseases (CVD). Objective To asses the relationship between homocysteine concentrations and the risk of CVD. Data Sources MEDLINE was searched for systematic reviews published from 01.01.2000 to 13.05.2004. We used the MEDLINE search key words (MeSH) words homocysteine AND cardiovascular diseases . MEDLINE was also searched for randomised controlled trials (RCT) from 01.01.2000 to 20.05.2004 with the same MeSH keywords, for the purpose of including the latest results. Study Selection We included studies if they had the proper study design and outcome measures. We excluded studies with deviating populations or studies that did not fulfill our standards. Data Extraction Data from 9 meta-analysis and 4 RCTs were included. We did a quality analysis of the studies and then compared the results. Conclusions All the 9 meta-analysis conclude that there is an association between homocysteine and CVD, however whether the association is causal or not is yet to be decided. The 4 RCTs conclude that the reduction of homocysteine has a small effect on the risk of CVD, but that there still may be an association. All the authors of the meta-analysis and RCTs are awaiting the results of further studies before drawing any final conclusions.