B Vitamins and Folic Acid: Take Them, but Not for Your Heart

The Norwegian study can be added to the growing list of studies that pretty much put the question to rest: B vitamin supplementation does not reduce risk for heart attack or stroke.

(Dr. Kilmer McCully has been curiously quiet on these findings. In one editorial, he did comment that he felt the negative findings of these studies were likely due to the 1998 FDA mandate that the U.S. food supply contain supplemental folic acid.)

Does that mean we should toss our B vitamins in the garbage?

No, absolutely not. Despite the now incontrovertible argument that B6, B12, and folic acid do not reduce cardiovascular events, several questions need answering:

• Why does homocysteine serve such a powerful role in predicting heart disease and stroke? Is it a marker for another process? Do B vitamins represent an incomplete solution and something crucial is missing from the treament regimen? Or, is it the wrong treatment altogether?
• Why do children with very high homocysteine levels appear to benefit from B vitamin supplementation?
  
• Are there subgroups of people with elevated homocysteine that may benefit while others do not? For instance, there are people with a genetic basis for elevated homocysteine that may represent a different pattern than people who have high homocysteines due to vitamin deficiencies.
  
• Do adults with very high levels of homocysteine, e.g., > 30 micromol/L, differ in some way? Are they more likely to benefit from either B vitamin supplementation or other treatments?
• Are there specific subgroups of people who have been shown to obtain exaggerated risk from elevated homocysteine, e.g., people with lipoprotein(a), a very high-risk pattern for heart disease, who may still benefit from B vitamin supplementation? (Lipoprotein(a) has been shown in several studies to interact with the homocysteine molecule.)

In everyday life, increased homocysteine can also signal deficiencies of vitamins B12 and folic acid, less commonly B6. While supplementation may not address cardiovascular risk, it can prevent anemia, help maintain stamina, improve mental function, and provide other health benefits.

In many ways, the failure of B vitamin supplementation opens more questions than it settles. While the simple notion of B vitamin supplementation and cardiovascular risk seems settled, there are plenty of more issues to explore. Homocysteine research remains a fascinating area that is likely to yield more insights.

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Heart Disease, Homocysteine, B Vitamins--and You 

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