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Elevated plasma homocysteine as risk factor for peripheral arterial disease--what is the evidence?
1Oregon Health and Sciences University, Portland, OR 97201, USA.
Insights
Elevated homocysteine (HC) is linked to atherosclerotic disease. Vitamin therapy, particularly folate, effectively lowers HC with no side effects, showing promise for treating atherosclerosis.
Area of Science:
- Cardiovascular Medicine
- Nutritional Science
- Biochemistry
Background:
- Elevated plasma homocysteine (HC) is strongly associated with the presence and progression of atherosclerotic disease.
- Homocysteine is a risk factor for cardiovascular disease, independent of traditional risk factors.
Purpose of the Study:
- To review the evidence linking elevated homocysteine to atherosclerosis.
- To evaluate the efficacy and safety of vitamin therapy, specifically folate, in reducing homocysteine levels.
- To discuss the potential of vitamin therapy as a novel treatment for atherosclerosis.
Main Methods:
- Systematic review of existing epidemiological and clinical trial data.
- Analysis of studies investigating the effect of vitamin supplementation on plasma homocysteine levels.
- Evaluation of randomized clinical trials assessing the clinical benefits of homocysteine-lowering therapy.
Main Results:
- Consistent evidence demonstrates an independent association between elevated homocysteine and atherosclerotic disease.
- Vitamin therapy, primarily folate, reliably reduces homocysteine levels without significant toxicity or side effects.
- Two small randomized trials showed clinically relevant benefits of folate treatment in reducing homocysteine compared to placebo.
Conclusions:
- Folate therapy effectively lowers plasma homocysteine, a risk factor for atherosclerosis.
- Further large-scale clinical trials are ongoing to confirm the therapeutic potential of homocysteine-lowering vitamin therapy for atherosclerosis.
- Vitamin therapy represents a promising, low-risk, and cost-effective approach to managing atherosclerosis.
Abstract:
There is abundant evidence that elevated plasma homocysteine (HC) is independently associated with presence of atherosclerotic disease. There is credible evidence from a number of prospective studies that elevated HC is independently associated with progression of atherosclerotic disease. All studies to date agree that vitamin therapy, primarily folate, results in reliable decreases in HC, without recognized toxicity or side effects. Two small, randomized clinical trials have demonstrated clinically relevant benefit from folate treatment, which reduced HC in patients, compared to placebo. The results of multiple large scale clinical trials will be available within 2 to 5 years, and these have sufficient power to determine whether vitamin therapy intended to lower plasma HC will be established as the first effective therapy for atherosclerosis that does not involve expensive medication with toxic side effects and/or difficult changes in habits or lifestyle.