Health Tips & Articles

Heart Disease and Homocysteine

by Richard A. Shuman, MD

Have you ever had a friend or a relative experience a heart attack and ask yourself, "They were so healthy, why did they have a heart attack?" I must admit I do this all of the time but the individuals involved tend to be patients not family or friends. Nevertheless, the question of why some people have heart attacks and others are spared is an intriguing and complicated question. The first things to consider are risk factors for heart disease.

Risk Factors:

  1. Smoking
  2. Diabetes Mellitus
  3. Hypertension (high blood pressure)
  4. High LDL (bad cholesterol)
  5. Low HDL (good cholesterol)
  6. Family History of premature Heart Disease (age less than 50)

Unfortunately, there are many individuals who have heart attacks who have no risk factors. Physicians have known this for a long time but did not have a good explanation. Over the past several years the story of homocysteine has helped explain some of the mystery. Homocysteine is a breakdown product (actually an amino acid) from the digestion of meat and dairy products. It directly injures the wall of blood vessels as well as promoting clot formation, inhibiting clot breakdown and activating the LDL cholesterol. These actions significantly increase your risk for heart disease.

It has been suggested by leading cardiologists that 10-25 percent of all coronary heart disease (disease of the blood vessels which supply oxygen to your heart) can be attributed to high homocysteine levels. A level greater than 10 would be considered elevated.

If you have a high homocysteine level the treatment is very straightforward. You need to increase your intake of folate, B6 and B12. The most important of these three supplements would be folate. A simple multivitamin may be enough but I have some patients who have required as much as 4 milligrams of folate a day to bring their homocysteine level into the normal range.

RECOMMENDATIONS:

  1. Next time you visit your physician have them check a homocysteine level in addition to a cholesterol profile
  2. If you have a family history of early heart disease make sure you follow recommendation #1
  3. If your homocysteine level is above 10, increase the amount of folate, B6 and B12 in your diet. In addition take a folate supplement.

Richard Shuman M.D., Chief of Medicine RiverBend Medical Group

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