Can you tell me what the connection is between folic acid and the prevention of heart disease? All the hospital pathologists are taking it, and since my family has a high incidence of heart disease (at least among those who smoked and didn’t watch their diet), I am interested in how it works to prevent heart disease.
Since many of the risk factors for atherosclerosis (the process which leads to blockage of the coronary arteries and heart attacks) have become known, doctors have been puzzled by the occurrence of early heart attacks in people who have none of the known risk factors. Some people with normal cholesterol, who are non-smokers, non-diabetics, and non-hypertensive, have heart attacks at a relatively young age. This implies that there are other risk factors, which we have not yet discovered. It is beginning to look like a substance known as homocysteine (a metabolic byproduct found naturally in all of us) may be the culprit, or at least one of them.
In a study of 15,000 male U.S. physicians, the 5 percent with the highest homocysteine levels in their blood were found to have three times the risk of having a heart attack compared to those with a lower lever of homocysteine. When the researchers corrected for the other risk factors, a high homocysteine level remained a significant risk. Most commercial labs are now able to test for homocysteine to evaluate this risk.
So why am I going on about something as arcane as homocysteine levels when you asked why the pathologists in your hospital are taking folic acid? Folic acid, in doses of 1 to 2 milligrams per day, has been found to reduce elevated homocysteine levels. Pyridoxine (vitamin B6), vitamin B12, and betaine (Cystadene) also reduce the levels. Some experts are recommending folic acid for people with high levels, but since it is difficult to find out if you have a high level, the pathologists are probably just taking it anyway. Folic acid is safe and also prevents some serious birth defects in pregnant women. There is considerable interest now in mandating folic acid supplements in milk or foods. This interest is because of the birth defect problem, since no one has yet determined by a controlled study that taking folic acid will reduce the risk of heart attacks.
So sure, take folic acid, but realize that controlling cholesterol, hypertension, and smoking are probably still much more important for preventing heart disease. Also be sure to let your doctor know that you are taking folic acid, since it can mask a deficiency of vitamin B12, leading to serious complications in people with pernicious anemia who are unable to absorb vitamin B12.
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