Vitamins & Exercise
Heart Attack Prevention Series
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
Dennis Lee, MD
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Additional Heart Attack Prevention Information
- Heart Attack Prevention Overview
- Lowering Your Cholesterol
- Aspirin for Heart Attack Prevention and Treatment
- Omega-3 Fatty Acids
Homocysteine, folic acid, and B vitamins
Homocysteine is an amino acid that plays a role in coronary artery disease. It is metabolized (chemically transformed) into methionine and cysteine with the help of the B vitamins; folic acid (B9), B12, and B6 (pyridoxine). Therefore, insufficient amounts of these B vitamins in the body can theoretically hamper the metabolic breakdown of homocysteine, and hence increase its blood levels. High levels of homocysteine in the blood (hyperhomocysteinemia) can damage the inner surface of blood vessels, promote blood clotting, and accelerate atherosclerosis.
The current state of knowledge regarding folic acid, homocysteine, and heart attacks is as follows:
- The level of blood folate is an important determinant of the blood homocysteine level. Low blood folate levels are associated with high blood levels of homocysteine.
- Low blood folate is common among individuals who do not take multivitamins, but unusual among those who do.
- The consumption of folic acid supplements or folic acid fortified cereals can increase blood folate levels and decrease blood homocysteine levels.
- In a large population study involving women, those who had the highest consumption of folic acid (usually in the form of multivitamins) had fewer heart attacks than those who consumed the least amount of folic acid.
Even though current scientific evidence suggests that taking folic acid and vitamin B supplements to lower homocysteine levels should help prevent atherosclerosis and heart attacks, conclusive proof is still lacking because:
- There are no conclusive controlled studies demonstrating that increasing folic acid intake actually prevents atherosclerosis and heart attacks.
- There is no clinical study demonstrating that lowering blood levels of homocysteine actually prevents atherosclerosis and heart attacks.
There is also no official recommendation as to who should be tested for hyperhomocysteinemia. The optimal doses of the B vitamins, folic acid, B12, and B6, required to prevent and treat hyperhomocysteinemia are also uncertain. For folic acid, a daily dose of 0.8-1.0 mg is probably adequate.
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