Homocysteine lowering interventions for peripheral arterial disease and bypass grafts

Elevated plasma levels of the amino acid homocysteine (hyperhomocysteinaemia) are associated with hardening or blocking of the arteries (atherosclerosis) In addition, there is a poorer prognosis, both in the progression of the disease and outcome after therapy. Treatment to lower homocysteine levels has been shown to be both effective and cheap in healthy volunteers. However, the impact of reducing homocysteine levels on the progression of atherosclerosis and patency of vessels after treatment for atherosclerosis is still unknown and forms the basis for this review. To assess the effects of plasma homocysteine-lowering therapy on the clinical progression of disease in patients with peripheral arterial disease (PAD) and hyperhomocysteinaemia, including, as a subset, those who have undergone surgical or radiological intervention. The reviewers (MH,GS) searched the Cochrane Peripheral Vascular Diseases Group trials register, the Cochrane Controlled trials register (2002, Issue 1), MEDLINE, EMBASE and reference lists of relevant articles. Randomised trials of the treatment of hyperhomocysteinaemia in patients with peripheral arterial disease, before and after surgical or radiological intervention versus no treatment for hyperhomocysteinaemia. Two reviewers (MH,GS) independently assessed trial quality and extracted data. Information on adverse events was collected from the trials. There are currently no randomised trials available for analysis. Well constructed trials assessing the impact of the treatment of hyperhomocysteinaemia in patients with peripheral arterial disease are urgently required.