2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

. Author manuscript; available in PMC: 2017 Sep 21.

Published in final edited form as: Circulation. 2016 Nov 13;135(12):e726–e779. doi: 10.1161/CIR.0000000000000471


Recommendation for Homocysteine Lowering

COR	LOE	Recommendation

III: No Benefit	B-R	B-complex vitamin supplementation to lower homocysteine levels for prevention of cardiovascular events in patients with PAD is not recommended.^205–207

See Online Data Supplements 28 and 29.		Although patients with PAD have been shown to have increased plasma homocysteine levels compared with patients without PAD, there is no evidence that B-complex vitamin supplementation improves clinical outcomes in patients with PAD.²⁰⁷ The HOPE-2 trial randomized 5522 patients with atherosclerotic vascular disease, including symptomatic PAD, or diabetes mellitus with additional risk factors to receive folic acid/vitamin B6/vitamin B12 or placebo.^205,206 Despite lowering of homocysteine levels in the vitamin supplementation arm, there was no improvement in the primary endpoint of cardiovascular death, MI, or stroke.