叶酸联合维生素B补充剂与老年心血管疾病患者预后及全因死亡率相关性META分析

Folic Acid plus B Vitamin Supplementation on Prognosis and All-Cause Mortality in Old-er Patients with Cardiovascular Disease: A Meta Analysis

摘要: 背景：在观察性研究中，同型半胱氨酸水平降低，冠心病和中风发病率也相应降低。叶酸、维生素B6和B12可使同型半胱氨酸水平降低。本文目的旨在研究补充剂能否降低心血管疾病患者发生死亡事件的风险及改善预后。方法：我们对前瞻性研究进行了系统回顾和荟萃分析，以阐明叶酸、维生素B补充与老年心血管疾病患者预后及死亡率之间的关系。本文将“室性心律失常”“心室颤动”“心源性猝死”等作为检索词，通过Pubmed、Cochrane library、Embase、CNKI、万方数据库进行检索，对所有检索到的随机对照试验进行质量评估，Ｍeta分析通过ReviewManger5.3统计软件进行。结果：共纳入8项符合入选标准的随机对照试验(RCT)，试验组(服用叶酸及维生素B)患者共计11840例，对照组(服用安慰剂)患者共计15913例，将心源性猝死及其他原因致死的发生率作为观察的重点事件。Meta分析结果显示，服用叶酸及维生素B的试验组与对照组比较在预防心源性猝死方面无显著性差异(OR = 1.04, 95% CI 0.94~1.16, P = 0.46)；服用叶酸及维生素B的试验组在与对照组的全因死亡率无显著性差异(OR = 1.04, 95% CI 0.95~1.15, P = 0.38)。结论：虽然叶酸和维生素B6摄入与冠心病风险呈线性负相关，但在老年人群中，叶酸和维生素B的补偿并不能减少心源性猝死及其他原因致死的发生。分析结果不支持使用维生素B作为冠心病患者预防心源性猝死及其他原因致死的有效措施。

Abstract: Background: In observational studies, the lower the level of homocysteine, the lower the incidence of coronary heart disease and stroke. Folate, vitamin B6 and B12 can reduce the level of homocys-teine. The purpose of this paper is to investigate whether supplements can reduce the risk of mor-tality events and improve outcomes in patients with cardiovascular diseases. Methods: A systematic review and meta-analysis of prospective studies were conducted to clarify the relationship between folic acid and vitamin B supplements and the prognosis and mortality of elderly patients with car-diovascular disease. “Ventricular arrhythmia”, “ventricular fibrillation”, “sudden cardiac death”, were used as search terms and searched through Pubmed, Cochrane library, Embase, CNKI, Wan-fang database. After the quality of the retrieved RCTs was evaluated, Meta-analysis was conducted using ReviewManger5.3 statistical software. Results: A total of 8 randomized controlled trials (RCT) meeting the inclusion criteria, 11840 patients in test group (taking folic acid and vitamin B) and 15913 patients in control group (taking placebo) were included. The end event was the incidence of sudden cardiac death and other causes. Meta analysis showed that there was no significant differ-ence between the test group and the control group in sudden cardiac death (OR = 1.04, 95% CI 0.94~1.16, P = 0.46) and all-cause mortality (OR = 1.04, 95% CI 0.95~1.15, P = 0.38). Conclusion: Although folate and vitamin B6 intake are linearly inverse associated with coronary heart disease risk, compensation of folate and vitamin B does not reduce the occurrence of sudden cardiac death and other causes in the elderly population. The results of the analysis do not support the use of vitamin B as an effective measure to prevent sudden cardiac death and other causes in patients with coronary heart disease.