Homocysteine levels and lower rates of coronary heart disease and stroke

I’m now ready to add one more item to that short list of the only things in life we can be absolutely certain of:

• Death
• Taxes
• Misinformation about alternative health care

Last week I received this e-mail from an HSI member named Hilda: “I have heard that folic acid, vitamin B6 and B12 have been discovered to cause heart problems and as up to now we have been under the impression that it helped in the incidence of heart problems. I would welcome your advice.”

I expect that Hilda may have come across a report that glossed over the details of a recent New England Journal of Medicine (NEJM) study with some conflicting conclusions about B vitamins. And you can be absolutely certain of this: When alternative health care research results have gray areas, the mainstream media is going to seize on the negatives and bury any positives in the 15th paragraph.

It’s all about the homocysteine

The NEJM study starts off with acknowledgment that observational studies have found that “lower homocysteine levels are associated with lower rates of coronary heart disease and stroke.” And: “Folic acid and vitamins B-6 and B-12 lower homocysteine levels.”

So far so good.

As noted in previous e-Alerts, homocysteine is an amino acid that promotes the buildup of plaque on blood vessel walls. But homocysteine metabolism depends on nutrients such as such as the three mentioned above. So homocysteine levels tend to drop when these nutrients are increased.

In this new trial, researchers recruited more than 5,500 patients over the age of 55 who had vascular disease or diabetes. Half the subjects were randomly assigned to receive a daily combination of 2.5 mg of folic acid, 50 mg of vitamin B-6 and 1 mg of vitamin B-12, while half received placebo. Over a five-year intervention period, blood samples were taken before and after the study, and at the two-year mark. The primary outcome that researchers were looking for was death associated with stroke, heart attack or other cardiovascular causes.

Results showed that the B-vitamin combo significantly lowered homocysteine, while homocysteine levels rose in the placebo group. But the vitamin supplements did not significantly decrease the risk of death from cardiovascular causes or heart attack.

Digging down for the positives

When certain details are isolated, the NEJM study can be perceived as a failure for the vitamin supplements. But to come away with a negative message, you’d have to overlook some key details:

• A high homocysteine level is by no means the only risk factor for vascular disease-related death
• Fewer non-fatal strokes were recorded in the vitamin group than in the placebo group
• The vitamin combo DID lower homocysteine levels (Vascular disease is not the only health problem associated with high homocysteine – others include Alzheimer’s disease, memory loss, age-related macular degeneration and osteoporotic fractures)
• Higher vitamin doses might have been more effective (In the E-Alert “Mrs. Howell’s Secret” (3/25/04), HSI Panelist Allan Spreen, M.D., recommended 5 mg of folic acid, 100 mg of B-6 and 1 mg of B-12 for those with high homocysteine levels)

So for individuals who are free of cardiovascular conditions, this study actually offers good news. I hope that Hilda is in that group and will feel comfortable talking with her doctor or a health care professional about adding folate, B-6 and B-12 to her supplement regimen if necessary.

Sources:
“Homocysteine Lowering with Folic Acid and B Vitamins in Vascular Disease” New England Journal of Medicine, published online 3/12/06, content.nejm.org
“B-Vitamins ‘Not Beneficial’ to High-Risk Heart Patients” NutraIngredients, 3/13/06, nutraingredients.com