This trial is active, not recruiting.

Conditions cardiovascular disease, myocardial infarction, stroke, cancer
Treatment folic acid, vitamin b6 and b12 or placebo
Phase phase 4
Sponsor Hamilton Health Sciences Corporation
Collaborator Canadian Institutes of Health Research (CIHR)
Start date December 1999
End date October 2005
Trial size 5000 participants
Trial identifier NCT00106886, HOPE-2, CIHR FRN # MT-15428


The purpose of the HOPE-2 study is to determine whether long term supplementation with folic acid, vitamins B6 and B12 aimed at homocyst(e)ine reduction reduces the rates of major fatal and nonfatal cardiovascular events in patients with established cardiovascular disease and/or diabetes mellitus.

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Allocation randomized
Endpoint classification safety/efficacy study
Intervention model single group assignment
Masking double-blind
Primary purpose prevention

Primary Outcomes

The composite of cardiovascular death, myocardial infarction (MI) and stroke
time frame:

Secondary Outcomes

Total major ischemic events (includes CV [cardiovascular] death, MI, stroke, hospitalizations for UA [unstable angina] and revascularizations)
time frame:
Hospitalization for unstable angina
time frame:
Hospitalization for congestive heart failure (CHF)
time frame:
Hospitalization for revascularization procedures
time frame:
Total mortality
time frame:
Other hospitalizations
time frame:
Diabetic complications (laser therapy, dialysis, nephropathy or new diagnosis of diabetes)
time frame:
The composite of death due to cancer, hospitalization for cancer and new diagnosis of cancer
time frame:

Eligibility Criteria

Male or female participants at least 55 years old.

Inclusion Criteria: - Women and men 55 years of age or over with established CVD and at high risk for future fatal and nonfatal CV events, defined as: 1. Documented coronary artery disease (CAD); 2. Documented peripheral vascular disease (PVD); 3. Documented cerebrovascular disease; 4. Diabetes with one of the following; additional cardiovascular risk factors: i) hypertension (BP >160 mmHg systolic or >90 mmHg diastolic or on treatment); ii) total cholesterol >5.2 mmol/L (>200 mg/dl); iii) HDL cholesterol <0.9 mmol/L (3.5 mg/dl); iv) current cigarette smoker; v) any evidence of previous vascular disease - Provision of informed consent Exclusion Criteria: - Current use of any vitamin supplements containing folic acid >200 micrograms/day. The patients taking such vitamin supplements can be asked if they agree to discontinue these supplements. If they agree, they can be randomized to the study following a one month wash-out period. - Known previous adverse reactions to folic acid and/or vitamin B6 and/or B12. - Planned cardiac, peripheral or cerebrovascular revascularization, defined as a decision taken by the patient and his or her physician(s) to perform surgical or percutaneous transluminal revascularization within the next 6 months. - Hemodynamically significant primary valvular outflow tract obstruction (e.g. mitral stenosis, asymmetric septal hypertrophy, malfunctioning prosthetic valve). - Constrictive pericarditis. - Complex congenital heart disease. - Syncopal episodes presumed to be due to uncontrolled life-threatening arrhythmias (asymptomatic arrhythmias including ventricular tachycardia are not exclusion criteria. - Uncontrolled hypertension. - Cor pulmonale. - Heart transplant recipient. - Other important non-cardiovascular disease(s) expected to limit compliance and/or impact on patient's ability to complete the study, such as: *history of alcohol or drug abuse, *psychiatric disorders, *senility, *severe physical disability, *illnesses including terminal stage of cancer and other major systemic illnesses expected to limit the patient's ability to comply with the study protocol and to complete the study.

Additional Information

Official title HOPE-2 Study (Heart Outcomes Prevention Evaluation-2 Study)
Principal investigator Eva M Lonn, MD MSc FRCPC FACC
Description Cardiovascular disease (CVD) remains a major cause of mortality and morbidity in most developed countries and accounts for approximately 40% of all deaths in Canada. Reductions in cholesterol, lowering of blood pressure and smoking cessation have been shown to be effective strategies in cardiovascular prevention; however, these major "classical cardiovascular risk factors" along with nonmodifiable risk factors, cannot fully explain why certain individuals develop atherosclerotic cardiovascular diseases, while others do not. Other "emerging" cardiovascular risk factors are currently under investigation. There is a large body of consistent, biologically plausible evidence linking hyperhomocyst(e)inemia to cardiovascular risk and the association is graded. A simple, nontoxic therapeutic intervention in the form of multivitamins - folic acid and vitamins B6 and B12 - has been shown to be highly effective in reducing homocyst(e)ine levels, irrespective of the underlying cause. To date, however, there are no good clinical trials evaluating the efficacy of homocyst(e)ine-lowering therapies in reducing major cardiovascular events. The impact of this simple intervention on cardiovascular morbidity and mortality remains to be demonstrated. Study Hypothesis: Evaluate if long-term therapy with folic acid and vitamins B6 and B12 compared to placebo reduces the risk of major fatal and nonfatal cardiovascular events. Importance of the Study: The "homocyst(e)ine theory of atherosclerosis" remains an important unanswered question in cardiovascular medicine. If indeed a combination of multivitamins is found to be effective in reducing cardiovascular events, it is expected that this safe, inexpensive and easily administered therapy would be widely used world-wide. Therefore, the results of this trial could have a significant public health impact.
Trial information was received from ClinicalTrials.gov and was last updated in September 2005.
Information provided to ClinicalTrials.gov by McMaster University.