Homocysteine Lowering with Folic Acid and B Vitamins in Vascular Disease

In epidemiologic studies, the plasma total homocysteine level has been found to be a risk factor for cardiovascular disease. In the HOPE-2 trial of high-risk patients, treatment with folic acid, vitamin B 12 , and vitamin B 6 reduced plasma total homocysteine levels. However, treatment with B vitamins was not associated with a reduction in cardiovascular risk. Treatment with folic acid, vitamin B 12 , and vitamin B 6 reduced plasma total homocysteine levels. However, treatment with B vitamins was not associated with a reduction in cardiovascular risk. Numerous studies suggest that homocysteine may be a modifiable risk factor for cardiovascular disease. In experimental studies, homocysteine causes oxidative stress, damages endothelium, and enhances thrombogenicity. 1 – 3 In general, epidemiologic studies show an independent and graded association between homocysteine levels and cardiovascular risk. 4 – 8 The observational data suggest that even mild-to-moderate elevations in homocysteine increase cardiovascular risk; this observation is important, because such increases are common and can easily be corrected with safe and inexpensive therapy. Folic acid is the most important dietary determinant of homocysteine; daily supplementation with 0.5 to 5.0 mg typically lowers plasma homocysteine levels by about . . .