Dr. Marta Ebbing
WENBIT is one of the larger B-vitamin secondary prevention trials conducted in a population without mandatory folic acid fortification of foods. From 1999 to 2004, a total of 3090 patients (20.5% women) median (range) age 62 (28 – 87) years, undergoing coronary angiography for stable angina pectoris (84%), ACS (15%) or aortic valve stenosis (1%) at Bergen or Stavanger University, Western Norway, were included. Using two-by-two factorial design, participants were assigned to four groups receiving daily oral treatment with A) folic acid (0.8 mg)/vitamin B12 (0.4 mg)/vitamin B6 (40 mg), B) folic acid/vitamin B12, C) vitamin B6 alone or D) placebo. There were no significant differences in baseline characteristics between the four groups. Almost 60% of participants had 2- or 3-vessel disease. Homocysteine levels were lowered by 28% in groups receiving folic acid/vitamin B12, thus compliance was good. During a median follow-up of 38 months, 422 (13.7%) of patients experienced an event of the composite primary end point (all cause death, AMI, unstable angina pectoris or thromboembolic stroke). There were no significant differences in outcome when comparing groups receiving homocysteine-lowering folic acid or not, or comparing groups receiving vitamin B6 or not. In conclusion, WENBIT confirms and add additional evidence to the findings of earlier similar trials that have been completed the last few years.
At this time, B-vitamin supplementation is not justified as secondary prevention for coronary artery disease. To further assess possible effects of B-vitamin supplementation, meta-analyses of completed and ongoing trials should be conducted.
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