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Homocysteine, folic acid, B vitamins and cardiovascular risk
1Department of Internal Medicine, Broussais Hospital, APHP, Paris, France. jacques.blacher@brs.ap-hop-paris.fr
Insights
The link between high homocysteine levels and cardiovascular disease risk is debated, with evidence varying by population risk. Supplementation with folic acid and B vitamins shows potential benefits in intermediate outcomes, but definitive cardiovascular benefits are still under investigation.
Area of Science:
- Cardiovascular epidemiology
- Nutritional science
- Biochemistry
Background:
- Epidemiological studies suggest a link between plasma homocysteine and cardiovascular disease (CVD).
- The causal role of homocysteine as a CVD risk factor remains controversial.
- Evidence for an association is stronger in high-risk populations than in low-risk populations.
Purpose of the Study:
- To evaluate the controversial role of homocysteine in cardiovascular disease.
- To assess the potential cardiovascular benefits of folic acid and B vitamin supplementation.
Main Methods:
- Review of epidemiological evidence from prospective studies.
- Analysis of results from high-risk and low-risk populations.
- Examination of data from ongoing interventional trials.
Main Results:
- Association between elevated homocysteine and CVD risk is generally supported in high-risk populations.
- Weaker or no association observed in low-risk populations.
- No definitive proof of cardiovascular benefit from folic acid plus B vitamins supplementation yet, but intermediate endpoints show promise.
Conclusions:
- The role of homocysteine as a causal cardiovascular risk factor requires further investigation.
- Folic acid and B vitamin supplementation may offer benefits, supported by intermediate endpoint data.
- Ongoing trials will clarify the cardiovascular benefits of B vitamin supplementation in diverse populations.
Abstract:
Although there is considerable epidemiological evidence for a relationship between plasma homocysteine and cardiovascular disease, the role of homocysteine as a causal cardiovascular risk factor remains controversial. While results from high risk population based prospective studies generally support an association of elevated homocysteine levels with increased risk of cardiovascular disease, results from low risk population based prospective studies, however, tend to indicate a weaker association, or none at all. There is not yet any proof of a cardiovascular benefit mediated by folic acid plus B vitamins supplementation; nevertheless, some recent reports focusing on intermediate endpoints support the hypothesis of a benefit. Several interventional trials are underway and the answer of whether there is a cardiovascular benefit through folic acid plus B vitamins supplementation in different populations will be available in the years to come.