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Homocysteine (cont.)

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What should I do to prevent heart attacks and strokes?

Losing excess weight, exercising regularly, controlling diabetes and high blood pressure, lowering the bad LDL cholesterol, and stopping cigarette smoking are crucial steps in preventing heart attacks and strokes. The association between homocysteine levels and atherosclerosis is generally weaker compared to the known risk factors of diabetes, high blood pressure (hypertension), high cholesterol level, and cigarette smoking.

It is recommended that healthy adults eat more fresh fruits and vegetable, eat less saturated fat and cholesterol, and take one multivitamin daily. One multivitamin will supply 400 mcg (microgram or one-one thousandth of a gram)/day of folic acid in addition to vitamins B6, B12, and other important vitamins.

Who should undergo testing for homocysteine blood levels?

Some doctors screen for elevated homocysteine levels in patients with early onset of blood clot formation, heart attacks, strokes, or other symptoms related to atherosclerosis, especially if these patients do not have typical risk factors, such as smoking cigarettes, diabetes, high blood pressure, or high LDL cholesterol levels.

Currently, there are no official recommendations as to who should undergo testing for homocysteine blood levels. Before more scientific data become available from the currently ongoing studies, many experts do not recommend a screening test for blood homocysteine levels, even in patients with unexplained blood clot formation. In addition, the consensus recommendation is against treating elevated homocysteine levels with vitamins to prevent heart disease.

There is also no consensus as to the optimal dose of folic acid and other B vitamins for the treatment of elevated blood homocysteine levels. (For example, treatment of patients with high homocysteine levels may require higher doses of folic acid and other B vitamins than the amounts contained in a multivitamin.) Therefore, a decision regarding testing should be individualized after consulting with your doctor.


1. Ray, JG. Meta-analysis of hyperhomocysteinemia as a risk factor for venous thromboembolic disease. Arch Intern Med 1998; 158:2101.

2. den Heijer, M, Rosendaal, FR, Blom, HJ, et al. Hyperhomocysteinemia and venous thrombosis: a meta-analysis. Thromb Haemost 1998; 80:874.

3. Vermeulen, EG, Stehouwer, CD, Twisk, JW, et al. Effect of homocysteine-lowering treatment with folic acid plus vitamin B6 on progression of subclinical atherosclerosis: a randomised, placebo- controlled trial. Lancet 2000; 355:517.

4. Eikelboom, JW, Lonn, E, Genest, J Jr, et al. Homocyst(e)ine and cardiovascular disease: a critical review of the epidemiologic evidence. Ann Intern Med 1999; 131:363

5. Robinson, K, Arheart, K, Refsum, H, et al. for the European COMCAC Group. Low circulating folate and vitamin B6 concentrations. Risk factors for stroke, peripheral vascular disease, and coronary artery disease. Circulation 1998; 97:437.

6. He, K, Merchant, A, Rimm, EB, et al. Folate, vitamin B6, and B12 intakes in relation to risk of stroke among men. Stroke 2004; 35:169.

7. McNulty, H, Dowey le, RC, Strain, JJ, et al. Riboflavin lowers homocysteine in individuals homozygous for the MTHFR 677C->T polymorphism. Circulation 2006; 113:74.

Previous contributing author: Dennis Lee, M.D.

Last Editorial Review: 8/8/2008

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