Homocysteine: Cardiovascular Disease, and the Exploration of Preventative Approaches

FOR IMMEDIATE RELEASE
Los Angeles, California, United States of America (Free-Press-Release.com) September 23, 2010 -- September 23, 2010 - LOS ANGELES, CA - What exactly is homocysteine? Homocysteine is a type of amino acid, synthesized from the essential amino acid methionine, and cannot be synthesized by the human body alone. An essential amino acid means that it is a vital element of life. Methionine must be supplied by diet, and foods rich in this amino acid include sesame seeds, brazil nuts, fish, meats and some other plant seeds. Fruits, vegetables, and legumes are considerably low in methionine.

What does homocysteine have to do with heart health? Epidemiologic trials conducted over the past 25 years have provided ample support for the association of mild hyperhomocysteinemia (high levels of homocysteinemia) with an elevated risk of cardiovascular disease. The risk of cardiovascular events through mildly elevated serum homocysteine levels with a deficiency of folic acid and vitamin B12 was a unique target for preventative studies.

A few studies explore the link between homocysteine, folic acid, and B vitamins:
-The Women’s Antioxidant and Folic Acid Cardiovascular Study showed that supplemental folic acid and B vitamins do not lower the risk for important vascular events even though they lower homocysteine levels.
-The Vitamin Intervention for Stroke Prevention showed that although there was a dose dependant reduction in homocysteine levels, there was no reduction in vascular events.

-The Norwegian Vitamin Trial (NORVIT) showed that there was no significant effect of folic acid and B12 on the risk of recurrent heart attacks or sudden death from coronary artery disease. There was, however, a trend toward more heart attacks.
-The HOPE-2 prevention trial that showed that treatment consisting of vitamin B12, vitamin B6, and folic acid for 5 years was associated with a reduction in homocysteine levels.

Though many studies had success in lowering homocysteine levels, there was no measurable reduction in heart attack, stroke, or death from cardiovascular causes. So, if higher levels of homocysteine are linked to cardiovascular disease, then why doesn’t lowering homocysteine lower the risk of coronary problems? Perhaps the answer lies in why patients with elevated homocysteine are at risk for CVD. There has never been a definite, accepted reason explaining the CVD risk seen in patients with high homocysteine. Is homocysteine the atherogenic culprit or is it simply a marker of some other pathologic process? It has been proposed that homocysteine is simply indicative of impaired renal function, a major CVD risk factor, and perhaps treatment should be directed at the kidney and not the homocysteine per se.

To sum it up, we are just not as smart as we think we are in regard to determining most cardiovascular risk factors, and have thus far failed to discover others. It is speculative at best to predict what therapeutic manipulation of a given risk factor will do until it is subjected to properly designed, prospective, blinded outcome trials. It took many years before homocysteine was accepted as a risk factor, and it took a decade of excellent clinical trials to prove that treating it with B-vitamin and folic acid is no longer justified. Most of the data gathered from studies was focused on men, but now we have studies showing effects in women. To conclude, if B-vitamin and folic acid therapy is null, spending money on expensive homocysteine screening in patients and vitamin therapy is unjustified, and can be directed at better-proven therapies, including balanced diets to provide these supplements.

About Dr. Richman's Center for Cholesterol Management

The Center for Cholesterol Management is directed by Michael F. Richman, M.D., F.A.C.S., F.C.C.P, cardio thoracic surgeon and leading expert on cholesterol management and lipoprotein testing. Dr. Richman is a diplomat in the American Board of Surgery and the American Board of Thoracic Surgery, a fellow in the American College of Surgeons and a fellow in the American College of Chest Physicians. In 2002-2003, he was listed by the Consumers' Research Council of America in the "Guide to America's Top Surgeons." Dr. Richman is also the national heart health examiner for the Examiner.com and is the cholesterol expert on WebMD.com. The Center for Cholesterol Management is the only free-standing facility in Southern California to deliver state-of-the-art diagnosis and treatment of lipid disorders using advanced lipoprotein testing- the only test that provides both traditional lipids and the number of atherogenic particles to better identify and manage patients at risk for coronary heart disease. www.lipidcenter.com

Dr. Richman's Blogs
http://blogs.webmd.com/cholesterol-management/
http://www.examiner.com

To schedule an interview or to find out more about Dr. Richman and his services, contact: Caroline Taicher at (310) 713-0777 or email: info@maximuspublicrelations.com.

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