Homecysteine, Folic Acid and Vitamin B for the heart

There are many factors contributing to the formation of atherosclerotic plaque. Smoking, high serum LDL cholesterol, hypertension, diabetes, obesity, family history are all well documented risk factors for coronary artery disease. All textbooks also mention high serum homocysteine levels as a minor coronary risk factor for coronary artery disease. This may be related to it's role in the production of cholesterol.

Serum homocysteine levels can be surpressed with vitamin B and folic acid tablets. That sounds simple enough, except that so far, clinical trials in the use of folic acid and vitamin B to reduce major adverse cardiac events have drawn blanks. There seem to be no help taking folic acid and vitamin B to reduce MACCE in patients with CAD. AHA 2006 Chicago saw the presentation of yet another study. WAFACS, which again showed that there was no help taking Folic Acid and Vitamin B in females with known CAD. WAFACS join VISP, HOPE-2, and NORVIT as negative studies in the use of Folic Acid and vitamin B in the prevention of CAD and events resulting from CAD.

Does this mean that Homocysteine is not really a coronary risk factor? Maybe not, but it does look like the role of homocysteine is complicated and perhaps may not be so relevant. Personally, I do not routinely measure serum homocysteine. When in doubt, I use folic acid liberally, but actually there is little data to support that strategy, as shown again in Chicago AHA 2006. Of course, we could all eat more greens and fruits and forget about the role of homocysteine.