DLM: Homocysteine, Folate, B6 or B12 (2007-2011)
MEDLINE database search with keywords: “homocysteine” and “athlerosclerosis” filtered for human subjects
--looked at cohort and nested case-control studies that identified plasma Hcyt as exposure and first cardiovascular event as outcome
--checked references for additional eligible publicationscase-control excepted nested (nested are free from reverse causality bias and comparability of cases and controls is guaranteed)
--study outcomes: first cardiac events (fatal and non-fatal MI, death from cardiovascular causes, unstable angina, subsequent coronary artery bypass surgery, first CVA
--14 cohort studies
--data from 2529 cases and 7305 non-cases
--increments in plasma total Hcyt concentration results in significant increase in risk of cardiovascular disease (ARR=1.33, 95% CI: 1.21-1.47); p=0.004
--increase in coronary heart disease (ARR=1.49, 95% CI: 1.31-1.70); p=0.006
--increase in stroke (ARR=1.37, 95% CI: 0.99-1.91); p=0.328
--magnitude of average RR (ARR) not affected by age (p=0.83)
--duration of study follow-up did not affect results (p=0.25)
--hyperhomocysteinemia moderately increases risk for first CVD event
--is Hcyt the best marker to measure risk? Perhaps Hcyt-thiolactone is betterUniversity/Hospital: | Universidad Industrial de Santander (Columbia), Fundation Cardiovascular del Oriente Colombiano (Columbia) |
Quality Criteria Checklist: Review Articles
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Relevance Questions | |||
1. | Will the answer if true, have a direct bearing on the health of patients? | Yes | |
2. | Is the outcome or topic something that patients/clients/population groups would care about? | Yes | |
3. | Is the problem addressed in the review one that is relevant to dietetics practice? | Yes | |
4. | Will the information, if true, require a change in practice? | Yes | |
Validity Questions | |||
1. | Was the question for the review clearly focused and appropriate? | Yes | |
2. | Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? | Yes | |
3. | Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? | Yes | |
4. | Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? | Yes | |
5. | Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? | Yes | |
6. | Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? | Yes | |
7. | Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? | Yes | |
8. | Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? | Yes | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? | Yes | |
10. | Was bias due to the review's funding or sponsorship unlikely? | ??? | |