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Homocysteine and Heart Disease
What Is Homocysteine?

HCA image for aging hearts
Homocysteine is an amino acid formed in the body from another amino acid called methionine. Certain B vitamins are needed to breakdown these amino acids. The vitamins include vitamin B6, vitamin B12, and folate. A deficiency of any one of these vitamins, most particularly folate, can lead to an elevation in blood levels of homocysteine.

Does Homocysteine Increase the Risk of Heart Attack?

Levels of homocysteine increase with age, and elevation is more common in men and postmenopausal women. Although some studies have found an association with high homocysteine levels and heart disease, whether or not homocysteine is a risk factor for heart disease remains controversial.

During the last 2 decades, a connection between mild to moderate elevations of homocysteine and heart disease has shown up in some, but not all studies. Organizations like the American Heart Association (AHA) do not currently identify high homocysteine levels as a major risk factor for cardiovascular disease.

If you have not yet been tested, do not be surprised if your doctor is somewhat reluctant to measure your homocysteine level. If other risk factors for heart disease are already present, knowing that your homocysteine level is elevated may not change your treatment. However, according to the AHA, getting screened for homocysteine levels may be useful if you have a personal or family history of cardiovascular disease and do not have the common risk factors, like smoking, high blood pressure, high cholesterol.

What If You Have Elevated Homocysteine Levels?

Homocysteine levels are reduced when intake of folate, vitamin B6, and vitamin B12 is increased. However, studies have not shown that taking these vitamins can prevent or treat cardiovascular disease.

The AHA suggests that people at high risk should make sure they are getting enough folate, vitamin B6, and B12 in their diet. Your doctor can give you specific recommendations about the appropriate dosages for you. Here are the general recommendations for daily intake of folate, vitamin B6, and B12:

  • Folate
    • Males and females aged 14 and older—400 micrograms (mcg)
  • Vitamin B6
    • Males aged 19-50 years—1.3 milligrams (mg)
    • Males aged 51 years and older—1.7 mg
    • Females aged 19-50 years—1.3 mg
    • Females aged 51 years and older—1.5 mg
  • Vitamin B12
    • Males and females aged 14 years and older—2.4 micrograms

Here are a few examples of foods that are high in these vitamins:

  • Folate—citrus fruits, fortified breakfast cereal, vegetables
  • Vitamin B6—fortified breakfast cereal, bananas, baked potatoes with skin
  • Vitamin B12—fortified breakfast cereal, fish, meat, poultry, and dairy products

If you are concerned about your risk factors for heart disease or if you would like to take supplements, talk to your doctor to decide what the best approach would be based on your health and diet.

RESOURCES:

American Heart Association
http://www.heart.org

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.com

References:

Coronary Artery Disease: High Homocysteine Level: How It Affects Your Blood Vessels. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/coronary-artery-disease/causes-risk-factors/high-homocysteine-level-how-it-affects-your-blood-vessels.html. Updated May 2014. Accessed December 30, 2014.

Eikelboom JW, Lonn E, Genest J Jr, et al. Homocysteine and cardiovascular disease: a critical review of the epidemiologic evidence. Ann Intern Med.1999 Sep 7;131:363-375.

Hankey GJ, Eikelboom JW. Homocysteine and vascular disease. Lancet. 1999;354:407-413.

Homocysteine and cardiovascular disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 4, 2013. Accessed December 30, 2014.

Homocysteine, folic acid, and cardiovascular disease. American Heart Association website. Available at: http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Homocysteine-Folic-Acid-and-Cardiovascular-Disease_UCM_305997_Article.jsp. Updated March 18, 2014. Accessed December 30, 2014.

Liem A, Reynierse-Buitenwerf GH, Zwinderman AH, Jukema JW, van Veldhuisen DJ. Secondary prevention with folic acid: Effects on clinical outcomes. J Am Coll Cardiol. 2003;41:2105–2113.

Moustapha A, Robinson K. Homocysteine: an emerging age-related cardiovascular risk factor. Geriatrics.1999;41:49-51.

Pyridoxine. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed December 30, 2014.

Schnyder G, Roffi M, Flammer Y, Pin R, Hess OM. Effect of homocysteine-lowering therapy with folic acid, vitamin B12, and vitamin B6 on clinical outcome after percutaneous coronary intervention: the Swiss Heart study: a randomized controlled trial. JAMA. 2002;288:973–979.

Stein JH, McBride PE. Hyperhomocysteinemia and Athrosclerotic Vascular Disease: Pathophysiology, Screening, and Treatment. Arch Intern Med. 1998;158(12):1301-1306.

Vitamin B12. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 5, 2013. Accessed December 30, 2014.



Last reviewed December 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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