Homocysteine, Vitamins, and Coronary Artery Disease. Comprehensive Review of the Literature

Overview

Journal Can Fam Physician

Specialties General Medicine
Public Health

Date 2001 Jan 6

PMID 11143583

Citations 4

Authors

B V Taylor

G Y Oudit

M Evans

Affiliations

Soon will be listed here.

Abstract

Objective: To summarize results of clinical trials investigating the role of homocysteine (tHcy) as a risk factor for coronary artery disease (CAD) and the role of vitamin therapy (folic acid and vitamins B6 and B12) in primary and secondary prevention of CAD.

Quality Of Evidence: MEDLINE was searched from January 1976 to January 1999 to locate cross-sectional, retrospective and prospective cohort studies and meta-analyses on CAD using the MeSH words homocysteine, folic acid, vitamins B6 and B12, and coronary artery or heart disease.

Main Message: Elevated tHcy levels are prevalent; most retrospective and cross-sectional studies show an association with increased risk of CAD. Results from recent prospective studies are less consistent. Folic acid, alone or with vitamins B6 and B12, reduces tHcy concentrations in the blood. Results from ongoing randomized controlled trials could determine the effect of vitamins B6 and B12 and folic acid supplementation on CAD-related morbidity and mortality and could indicate whether routine supplementation with these vitamins should be advocated. Before mass screening for tHcy can be done, the tHcy assay must be standardized.

Conclusion: The role of homocysteine and vitamins B6 and B12 in managing CAD is unclear. Routine screening is not recommended.

Citing Articles

Hyperhomocysteinemia and Low Folate and Vitamin B12 Are Associated with Vascular Dysfunction and Impaired Nitric Oxide Sensitivity in Morbidly Obese Patients.

Haloul M, Vinjamuri S, Naquiallah D, Mirza M, Qureshi M, Hassan C Nutrients. 2020; 12(7).

PMID: 32645905 PMC: 7400872. DOI: 10.3390/nu12072014.

B12 and Folate Concentrations in Opium Addicts Compared to Healthy Subjects: A Case Control Study from Kerman Coronary Artery Disease Risk Study.

Gholamhossenian A, Shahouzehi B, Shokoohi M, Najafipour H Addict Health. 2019; 10(3):198-204.

PMID: 31105918 PMC: 6511400. DOI: 10.22122/ahj.v10i3.547.

Stearoyl-CoA Desaturase-1: Is It the Link between Sulfur Amino Acids and Lipid Metabolism?.

Poloni S, Blom H, Schwartz I Biology (Basel). 2015; 4(2):383-96.

PMID: 26046927 PMC: 4498306. DOI: 10.3390/biology4020383.

Vitamin B6: a molecule for human health?.

Hellmann H, Mooney S Molecules. 2010; 15(1):442-59.

PMID: 20110903 PMC: 6257116. DOI: 10.3390/molecules15010442.

References

Mudd S, Skovby F, Levy H, Pettigrew K, Wilcken B, Pyeritz R . The natural history of homocystinuria due to cystathionine beta-synthase deficiency. Am J Hum Genet. 1985; 37(1):1-31. PMC: 1684548. View

Kang S, Wong P, Cook H, Norusis M, MESSER J . Protein-bound homocyst(e)ine. A possible risk factor for coronary artery disease. J Clin Invest. 1986; 77(5):1482-6. PMC: 424549. DOI: 10.1172/JCI112461. View

Pancharuniti N, Lewis C, SAUBERLICH H, Perkins L, Go R, Alvarez J . Plasma homocyst(e)ine, folate, and vitamin B-12 concentrations and risk for early-onset coronary artery disease. Am J Clin Nutr. 1994; 59(4):940-8. DOI: 10.1093/ajcn/59.4.940. View

Robinson K, Arheart K, Refsum H, Brattstrom L, Boers G, Ueland P . Low circulating folate and vitamin B6 concentrations: risk factors for stroke, peripheral vascular disease, and coronary artery disease. European COMAC Group. Circulation. 1998; 97(5):437-43. DOI: 10.1161/01.cir.97.5.437. View

Dalery K, Selhub J, Davignon J, Latour Y, Genest Jr J . Homocysteine and coronary artery disease in French Canadian subjects: relation with vitamins B12, B6, pyridoxal phosphate, and folate. Am J Cardiol. 1995; 75(16):1107-11. DOI: 10.1016/s0002-9149(99)80739-5. View

Taylor Jr L, DeFrang R, Harris Jr E, Porter J . The association of elevated plasma homocyst(e)ine with progression of symptomatic peripheral arterial disease. J Vasc Surg. 1991; 13(1):128-36. DOI: 10.1067/mva.1991.24913. View

Jacobsen D, Gatautis V, Green R, Robinson K, Savon S, Secic M . Rapid HPLC determination of total homocysteine and other thiols in serum and plasma: sex differences and correlation with cobalamin and folate concentrations in healthy subjects. Clin Chem. 1994; 40(6):873-81. View

Kang S, Wong P, Norusis M . Homocysteinemia due to folate deficiency. Metabolism. 1987; 36(5):458-62. DOI: 10.1016/0026-0495(87)90043-6. View

Rinehart J, GREENBERG L . Arteriosclerotic lesions in pyridoxine-deficient monkeys. Am J Pathol. 1949; 25(3):481-91. PMC: 1942913. View

10.

Boushey C, Beresford S, Omenn G, Motulsky A . A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. JAMA. 1995; 274(13):1049-57. DOI: 10.1001/jama.1995.03530130055028. View

11.

Wald N, Watt H, Law M, Weir D, McPartlin J, Scott J . Homocysteine and ischemic heart disease: results of a prospective study with implications regarding prevention. Arch Intern Med. 1998; 158(8):862-7. DOI: 10.1001/archinte.158.8.862. View

12.

Wilcken D, Wilcken B . The pathogenesis of coronary artery disease. A possible role for methionine metabolism. J Clin Invest. 1976; 57(4):1079-82. PMC: 436752. DOI: 10.1172/JCI108350. View

13.

van Bockxmeer F, Mamotte C, Vasikaran S, Taylor R . Methylenetetrahydrofolate reductase gene and coronary artery disease. Circulation. 1997; 95(1):21-3. DOI: 10.1161/01.cir.95.1.21. View

14.

Nygard O, Nordrehaug J, Refsum H, Ueland P, Farstad M, Vollset S . Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med. 1997; 337(4):230-6. DOI: 10.1056/NEJM199707243370403. View

15.

Brattstrom L, Lindgren A, Israelsson B, MALINOW M, Norrving B, Upson B . Hyperhomocysteinaemia in stroke: prevalence, cause, and relationships to type of stroke and stroke risk factors. Eur J Clin Invest. 1992; 22(3):214-21. DOI: 10.1111/j.1365-2362.1992.tb01829.x. View

16.

Gallagher P, Meleady R, Shields D, Tan K, McMaster D, Rozen R . Homocysteine and risk of premature coronary heart disease. Evidence for a common gene mutation. Circulation. 1996; 94(9):2154-8. DOI: 10.1161/01.cir.94.9.2154. View

17.

Rasmussen K, Moller J, Lyngbak M, Pedersen A, Dybkjaer L . Age- and gender-specific reference intervals for total homocysteine and methylmalonic acid in plasma before and after vitamin supplementation. Clin Chem. 1996; 42(4):630-6. View

18.

Brattstrom L, Hultberg B, Hardebo J . Folic acid responsive postmenopausal homocysteinemia. Metabolism. 1985; 34(11):1073-7. DOI: 10.1016/0026-0495(85)90082-4. View

19.

Genest Jr J, McNamara J, Salem D, Wilson P, Schaefer E, MALINOW M . Plasma homocyst(e)ine levels in men with premature coronary artery disease. J Am Coll Cardiol. 1990; 16(5):1114-9. DOI: 10.1016/0735-1097(90)90542-w. View

20.

Petri M, Roubenoff R, Dallal G, Nadeau M, Selhub J, Rosenberg I . Plasma homocysteine as a risk factor for atherothrombotic events in systemic lupus erythematosus. Lancet. 1996; 348(9035):1120-4. DOI: 10.1016/S0140-6736(96)03032-2. View