For several years now, researchers have repeatedly shown that elevated levels of homocysteine in the blood are correlated with an increased risk of cardiovascular disease. In addition, supplements of three B vitamins (folic acid, pydridoxine and Vitamin B-12) have consistently been shown to lower blood levels of homocysteine. More and more, doctors are measuring homocysteine levels and recommending supplements of B vitamins when levels are elevated (above 9 micromoles/L).

A new study of 205 patients who had undergone angioplasty yields the first direct proof in humans that lowering moderately elevated homocysteine levels (average of 11.1) does indeed help slow the clogging of damaged heart arteries.1 Angioplasty uses a thin tube to insert a balloon into narrowed portions of arteries. When the balloon is inflated, it compresses the plaque and stretches the artery open. However, angioplasty also damages the artery walls, and this can often lead to rapid return of blockages, called restenosis, in the ?cleaned-out? arteries. This study showed that the group of patients given the B vitamins (folate -- 1 mg, pyridoxine -- 10 mg, and vitamin B-12 -- 400mcg) experienced a drop in homocysteine levels to an average of 7.2. More importantly it also showed that after 6 months, the patients receiving the B vitamins experienced significantly less restenosis than the control group (given only a placebo) and also experienced about half as many major adverse cardiac events, including heart attacks and the need for additional cardiovascular surgery.Bottom Line: The authors concluded, ?treatment with a combination of folic acid, vitamin B-12, and pyridoxine significantly reduces the rate of restenosis and the need for revascularization surgery of the target lesion after angioplasty. This inexpensive treatment, which has minimal side effects, should be considered as adjunctive therapy for patients undergoing coronary angioplasty.? Because restenosis shares many of the same risk factors as atherosclerosis, this study also strengthens the argument that all people with elevated homocysteine levels need increased levels of B vitamins. A DASH-style diet that provides high amounts of many nutrients has also been shown to lower elevated levels (above 9.0) of homocysteine. In lower risk patients, a clinical trial with a diet rich in fruits, vegetables, whole grains and nonfat dairy products and less salt will lower not only homocysteine levels but also blood pressure and cholesterol levels.1. N Engl J Med 2001;345:1593-1604