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Titolo:
Preventive health care, 2000 update: screening and management of hyperhomocysteinemia for the prevention of coronary artery disease events
Autore:
Booth, GL; Wang, EEL;
Indirizzi:
Univ Toronto, Dept Med, Toronto, ON, Canada Univ Toronto Toronto ON Canada iv Toronto, Dept Med, Toronto, ON, Canada Univ Toronto, Dept Pediat Clin Epidemiol, Toronto, ON, Canada Univ Toronto Toronto ON Canada ediat Clin Epidemiol, Toronto, ON, Canada Univ Toronto, Hlth Care Res Program, Toronto, ON, Canada Univ Toronto Toronto ON Canada lth Care Res Program, Toronto, ON, Canada
Titolo Testata:
CANADIAN MEDICAL ASSOCIATION JOURNAL
fascicolo: 1, volume: 163, anno: 2000,
pagine: 21 - 29
SICI:
0820-3946(20000711)163:1<21:PHC2US>2.0.ZU;2-W
Fonte:
ISI
Lingua:
ENG
Soggetto:
METHYLENETETRAHYDROFOLATE REDUCTASE GENE; PLASMA TOTAL HOMOCYSTEINE; ISCHEMIC-HEART-DISEASE; ACUTE MYOCARDIAL-INFARCTION; CARDIOVASCULAR RISK FACTOR; FOLIC-ACID FORTIFICATION; VASCULAR-DISEASE; HOMOCYST(E)INE LEVELS; ATHEROSCLEROTIC DISEASE; ELDERLY POPULATION;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
107
Recensione:
Indirizzi per estratti:
Indirizzo: Booth, GL Parkwood Hosp, Canadian Task Force Prevent Hlth Care, 801 Commissioners Rd, London, ON N6C 5J1, Canada Parkwood Hosp 801 Commissioners Rd London ON Canada N6C 5J1 nada
Citazione:
G.L. Booth e E.E.L. Wang, "Preventive health care, 2000 update: screening and management of hyperhomocysteinemia for the prevention of coronary artery disease events", CAN MED A J, 163(1), 2000, pp. 21-29

Abstract

Objective: To establish guidelines for the screening and treatment of hyperhomocysteinemia in the investigation and management of coronary artery disease (CAD). Options: Measurement of plasma total homocysteine (tHcy) levels in the fasting state or 4-6 hours after oral methionine load; vitamin supplementationwith folic acid and vitamins B-6 and B-12; adherence to the recommended daily allowance of dietary sources of folate and vitamins B-6 and B-12. Outcomes: This article reviews the available evidence on the association between plasma tHcy levels and CAD and the effect of lowering tHcy levels through vitamin supplementation or dietary intake. Evidence: MEDLINE was searched for relevant English-language articles published from January 1966 to lune 1999; also reviewed were additional articles identified from the bibliographies. Benefits, harms and costs: Cardiovascular disease is the leading cause of death in Canada. Homocysteine, generated in the metabolism of methionine, may have a role in the development of cardiovascular disease. The prevalenceof hyperhomocysteinemia in the general population is between 5% and 10% and may be as high as 30%-40% in the elderly population. if population-based studies are correct, tHcy may be responsible for up to 10% of CAD events and thus may represent an important and potentially modifiable risk factor for cardiovascular disease. Laboratory testing for tHcy is currently restricted to research centres, and costs range from $30 to $50 per person. Newer, less costly techniques have been developed and should become readily available with time. Values: The strength of evidence was evaluated using the methods of the Canadian Task Force on Preventive Health Care. Recommendations: Although there is insufficient evidence to recommend the screening or management of hyperhomocysteinemia at present (grade C recommendation), adherence to recommended daily allowance of dietary sources of folate and vitamins B-12 and B-6 should be encouraged. If elevated tHcy levels are discovered, vitamin deficiency should be ruled out to allow specific treatment and prevention of complications, such as neurological sequelae due to vitamin B-12 deficiency. Experts in the field advocate treatment of elevated tHcy levels in high-risk people, such as those with a personal or family history of premature atherosclerosis or a predisposition to develop hyperhomocysteinemia. Definitive guidelines for the management of hyperhomocysteinemia await the completion of randomized trials to establish the effectof vitamin supplementation on CAD events. Validation: The findings of this analysis were reviewed through an iterative process by the members of the Canadian Task Force on Preventive Health Care. Sponsors: The Canadian Task Force on Preventive Health Care is funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 20/09/20 alle ore 06:08:37