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Folate to prevent strokes and heart disease.

Of course, you get your cholesterol ratios checked when you go in for a physical, but now add a blood test for your homocysteine level.

For some, a high homocysteine level might be a more important risk factor for cardiovascular disease than a high cholesterol level. Not every heart attack or stroke victim has high cholesterol, is a smoker, or has any of the other known high risk factors.

High homocysteine levels can be lowered with folate and other B vitamins, such as [B.sub.12] and [B.sub.6]. Because these are safe water-soluble vitamins that have been proven to lower dangerous homocysteine levels, wouldn't it be prudent to consume these vitamins either by increasing spinach, beans, lentils, and green leafy vegetables, or by taking supplements?

If there's one malady Americans ought to know plenty about, it's heart disease. After all, heart attacks and strokes have been the subject of intense study for more than 50 years. Researchers have linked heart disease to a half-dozen causes that most people can recite by heart: smoking, high cholesterol, high-fat content, high blood pressure, obesity, and so on. Yet, it may come as a surprise to some that researchers know at most only half of the unfolding story of how and why people develop heart disease.

In the medical literature, certain heart attack cases remain mysteries--sudden deaths that occur in people who are seemingly healthy and lead otherwise healthful lifestyles. These people exercise, eat low-fat diets, don't have elevated cholesterol levels, don't smoke, yet their arteries clog up. Clearly, there must be unknowns that factor into such cases.

Free radicals form one theory, genetics another. Recently, heart researchers discovered a further, more promising clue that may help us understand how heart disease happens and how to prevent it.

Fittingly, the new information comes from the Framingham Heart Study, one of the longest-running and most productive heart disease research projects ever. All the identifiable heart-risk factors stem from this study. The Framingham project was initiated in 1948, using the 5,209 residents of Framingham, Massachusetts, as subjects. Only 1,400 of the original subjects are still living, but the study continues, now including a second generation of 5,000 who entered the program in 1971.

A little more than three years ago, Tufts University researchers initiated a study of 1,000 elderly volunteers from the original Framingham group. The team wanted to see if there was a relationship between an amino acid called homocysteine and narrowing of the carotid artery caused by atherosclerotic plaque buildup. Homocysteine is not new to researchers. For some time, it has been established that homocysteine can be toxic to blood-vessel walls at excess amounts in the bloodstream. The damage it causes can lead to plaque buildup, resulting in heart attacks and strokes. Therefore, it wasn't surprising that narrowed carotid arteries correlated closely in the study with elevated blood levels of homocysteine. What was of greater import for you and me was another connection between the subjects' estimated consumption of folate, [B.sub.12], and [B.sub.6] and their blood levels of the damaging homocysteine amino acid.

Previous studies had already shown that the majority of Framingham volunteers with high blood homocysteine levels also had low blood levels of three B vitamins: folic acid, [B.sub.12], and [B.sub.6]. However, these low vitamin levels had not yet been associated with risk for disease. The Tufts University study showed that the Framingham subjects who were getting inadequate B-vitamin and folic acid in their diets--and who had low blood levels of folic acid, vitamin [B.sub.12], and vitamin [B.sub.6]--had higher-than-normal blood levels of homocysteine. Many had carotid-artery stenosis, placing them at an increased risk for stroke. The study successfully linked an increased risk for vascular disease to elevated homocysteine levels and, more important, to low blood levels of B vitamins, folic acid, and vitamin [B.sub.6].

In short, it appears B vitamins can protect us from heart disease. How they do this is a bit complicated. Generally, it works like this: Homocysteine is a nonessential amino acid, meaning that it is created in the body and is not introduced through diet. It is a by-product of methionine, an essential amino acid that the body cannot synthesize, but must obtain from plant and animal protein. Homocysteine is produced in biochemical reactions involving methionine that are important for the normal functioning of DNA, proteins, and lipids. To keep up with the body's demand for methionine, homocysteine is recycled back to methionine in a reaction that requires folate and vitamin [B.sub.12]. Homocysteine is also eliminated in a reaction that involves vitamin [B.sub.6]. Consequently, folic acid, vitamin [B.sub.12], and vitamin [B.sub.6] are crucial for maintaining the proper balance of homocysteine levels in the body, and inadequate levels of either B vitamin, but especially folic acid, could tilt the balance in favor of homocysteine.

The bottom line is: we all need to get plenty of the three B vitamins through diet and vitamin supplementation. It also means that doctors may have a new and important risk factor to work with. Testing people's homocysteine levels may become as standard in assessing heart disease and heart disease risk as testing for cholesterol levels.

Anyone wishing to read an in-depth article about the researchers who brought us the above information should obtain the May/June 1995 issue of The Saturday Evening Post. It also contains references for folate and [B.sub.12].

We checked on the availability of testing for homocysteine blood levels. We found that Corning/ Metpath has 23 regional labs throughout the country that--with a physician's order--can test for serum homocysteine levels at a cost of $83. A test for folate costs $47.

Physicians can contact Corning/ Metpath at 800-638-7284. Mayo Clinic's laboratories also test for homocysteine levels; their test costs around $100. Physicians can contact the Mayo Clinic in Rochester, Minnesota, by calling 800-533-1710. --Cory SerVaas, M.D., Christina Ferroli, Ph.D., and Ted Kreiter
COPYRIGHT 1995 Benjamin Franklin Literary & Medical Society, Inc.
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Author:SerVass, Cory
Publication:Medical Update
Date:May 1, 1995
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