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Should hyperhomocysteinemia be treated in patients with atherosclerotic disease?

Bradley A Maron1, Joseph Loscalzo

  • 1Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.

Current Atherosclerosis Reports
|November 16, 2007
PubMed

Insights

Folic acid therapy effectively lowers homocysteine but hasn't shown clinical benefit for secondary cardiovascular event prevention in mild cases. Its role in severe hyperhomocysteinemia or primary prevention is still uncertain.

Area of Science:

  • Cardiovascular Medicine
  • Nutritional Science
  • Clinical Trials

Background:

  • Elevated homocysteine is linked to increased risk of myocardial infarction, stroke, and peripheral vascular disease.
  • Folic acid therapy significantly reduces homocysteine levels.

Purpose of the Study:

  • To evaluate the clinical benefit of folic acid therapy in cardiovascular event prevention.
  • To address the unresolved questions regarding folic acid's role in different homocysteine severity levels and primary prevention.

Main Methods:

  • Review of observational studies and large, randomized controlled trials.
  • Analysis of intervention trials limited to patients with mild hyperhomocysteinemia.

Main Results:

  • Recent trials failed to demonstrate clinical benefit of folic acid-induced homocysteine reduction for secondary cardiovascular prevention.
  • Current evidence suggests folic acid therapy is not recommended for mild hyperhomocysteinemia.

Conclusions:

  • The efficacy of folic acid therapy for intermediate or severe hyperhomocysteinemia remains undetermined.
  • The potential benefit of folic acid for primary prevention of cardiovascular diseases in low- or intermediate-risk individuals requires further investigation.

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