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  1. Alistair Lindsay, Editor

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Meta-analysis shows no clear benefit from folate supplementation ▸

Although several epidemiological studies have suggested that folate supplements can decrease the risk of cardiovascular disease, the results of clinical trials to date have been mixed. To investigate this further, Bazzano and colleagues performed a meta-analysis of all folate supplementation trials performed over the past 40 years that were found on a MEDLINE search. From 165 relevant reports, only 12 randomised controlled trials compared folate supplementation with placebo or usual care and used clinical cardiovascular disease as an end point; in total these trials analysed 16 958 participants. The overall relative risks of cardiovascular outcomes for patients treated with folate supplementation were 0.95 (CI 0.88 to 1.03) for cardiovascular disease overall, 1.04 (0.92 to 1.17) for coronary heart disease, 0.86 (0.71 to 1.04) for stroke and 0.96 (0.88 to 1.04) for all-cause mortality. The relative risk was consistent among patients with pre-existing renal or cardiovascular disease. Thus, no overall net benefit of folate supplementation on cardiovascular disease or all-cause mortality was shown. Several ongoing trials with large sample sizes may provide a definitive answer to this question.

Bupropion safe and effective for smoking cessation following acute coronary syndromes ▸

Cardiovascular mortality following myocardial infarction (MI) can be reduced by cessation of smoking. Bupropion is effective for smoking cessation, but its safety and efficacy in hospitalised smokers with acute cardiovascular disease has not previously been studied. A total of 248 smokers admitted with acute coronary syndromes were randomised to 12 weeks of sustained-release bupropion (300 mg) or placebo. In addition, all subjects had smoking-cessation counselling in the hospital and for 12 weeks after discharge. Follow-up of tobacco abstinence, cardiovascular mortality and new cardiovascular events was made at 3 months and 1 year. Validated tobacco abstinence rates in bupropion and placebo groups were 37.1% vs 26.8% (odds ratio (OR) 1.61; p = 0.08) at 3 months and 25.0% vs 21.3% (OR 1.23; p = 0.49) at 1 year. …

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