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[Homocysteine levels: measure or not?]

Yvo M Smulders1, Martin den Heijer, Henk J Blom

  • 1VU Medisch Centrum, Amsterdam.

Nederlands Tijdschrift Voor Geneeskunde
|October 31, 2013
PubMed

Insights

Elevated homocysteine levels, even within the normal range, predict cardiovascular risk. However, B vitamin trials show no reduction in cardiovascular disease, suggesting caution in screening and treatment for hyperhomocysteinaemia.

Area of Science:

  • Biochemistry
  • Cardiovascular Medicine
  • Nutritional Science

Background:

  • Elevated fasting plasma homocysteine is a significant cardiovascular risk factor.
  • Hyperhomocysteinaemia is commonly caused by low B vitamin levels or reduced kidney function.

Purpose of the Study:

  • To evaluate the effectiveness of B vitamin interventions in reducing cardiovascular disease in individuals with hyperhomocysteinaemia.
  • To address methodological limitations in previous interventional trials.

Main Methods:

  • Review of interventional trials using B vitamins to lower homocysteine levels.
  • Analysis of trial designs, participant selection, and dosage considerations.

Main Results:

  • B vitamin interventions effectively lowered homocysteine concentrations.
  • No significant reduction in cardiovascular disease rates was observed in treated individuals.
  • Methodological concerns include focus on mild hyperhomocysteinaemia and potential effects of high-dose folic acid.

Conclusions:

  • Current evidence does not support widespread screening for hyperhomocysteinaemia.
  • Screening is recommended only for severe premature vascular disease or suspected inherited disorders.
  • Treatment with B vitamins should be reserved for severe cases of hyperhomocysteinaemia.

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