A critical review of a journal article on treating cardiovascular disease
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A Critical review of a journal article on treating cardiovascular disease author: 孙天 date: 2011/4/6
1 A Critical review of a journal article on treating cardiovascular disease
I introduction：
This article is from BMJ journal , the title is ‘effects of B vitamins and omega- 3 fatty
acids on cardiovascular disease: a randomized placebo controlled trial’1
i background
In recent years ,some observational studies52 have reported supplement of folic acid,
vitamin B6,B12can decrease concentrations of plasma homocysteine levels in the pa-tients with cardiovascular disease ,this can lower the risk of coronary heart disease
and stroke. another studies106 also reported omega 3 fatty acids have beneficial ef-fect on cardiovascular disease .
ii Thesis statement
the aim of this article is to investigate whether dietary supplement with B vitamins or
omega 3 fatty acids, or both, could prevent major cardiovascular events in patients
with a history of ischaemic heart disease or stroke.
IISummary of the text
Researchers chose 2501 patients (all from France, aged 45-80 years who had an acute
coronary or cerebral ischaemic event within the 12 months before randomisation )
used double blind, randomized, placebo controlled factorial design to tested the sepa-rate and combined effects of supplements with B vitamins and omega 3 fatty acids for
the prevention of cardiovascular disease. Researchers ask about any serious disease
outcomes, treatment compliance, presence of cardiovascular risk factors, and adverse
effects by mailing questionnaires to all the participants every six months after enrol-ment. There are two end points: the primary end point was the first major cardiovas-cular event, the secondary end points was acute coronary syndrome without myocar-dial infarction, resuscitation from sudden death etc. The conclusion is that B vitamins A Critical review of a journal article on treating cardiovascular disease author: 孙天 date: 2011/4/6
2 and omega 3 fatty acids have no significant effects on risk of cardiovascular disease.
III Evaluation
i Strengths of this article :
Firstly, this research used double blind, randomized , placebo controlled trial, this can
ensure the results more realistic and reliable, more effective in preventing measure-ment bias. Secondly, the criterion of inclusion and exclusion are explicit. Thirdly, this
trial is the first assessed the effects of 5-methyltetrafolate, which has a closer resem-blance to the naturally occurring 5-methyltetrahydrofolic acid, it is as effective as fol-ic acid, but without the potential disadvantage of masking anaemia from vitamin B-12
deficiency. Fourthly, describe the completeness of outcome data for each main out-come, and incomplete outcome datas adequately addressed, this makes the report of
this study free of suggestion of selective outcome, and the results is integrity and cre-dibility. Fifthly, complete endpoint data is availability and the adjudication of end
point by professional blinded to treatment allocation. Lastly, in the previous para-graph of the conclusion, this study also makes comparisons with other trials, this can
help readers better understanding the background of this trial, and prompt researchers
to make further study.
ii limitations of this article:
Firstly, this trial was carried out only in France, whether there is racial differences is
not sure, and I suspect that this could overestimation the plasma homocysteine con-centration. Secondly, the duration of follow-up is short, this can not ensure to provide
appropriate statistical power to detect effects on major vascular events. Thirdly, forest
plot is not complete and clear, so some related information can not read. Fourthly,
during a mediation of 4.7 years of follow-up, routine use of dietary supplements con-taining B vitamins had better effect on experimental group with stroke compared with
control group with stroke, but further research is not done to clarify this issue.
IV Conclusion
This journal article do not support the routine use of dietary supplements containing B A Critical review of a journal article on treating cardiovascular disease author: 孙天 date: 2011/4/6
3 vitamins and omega 3 acids for the prevention of cardiovascular disease in people
with a history of cardiovascular disease, especially when supplement starts after the
phase of the initial event .But dietary supplements containing B vitamins had better
effect on stroke, and follow-up of this trail is very short, so some relative results are
worthy of making further study.
Reference:
1 Galan P, Kesse-Guyot E, et al. effects of B vitamins and omega 3 fatty acids on car-diovascular disease: a randomized placebo controlled trial. BMJ 2010; 341:c6273.
