Each issue of the Johns Hopkins Heart Bulletin features a Grand Rounds section in which Hopkins specialists answer readers’ questions about heart health. Here’s a sample.
Q. I know that homocysteine was in the news several years ago, when it was identified as a marker for heart disease risk. I haven’t heard much about homocysteine since then. My wife says I should take folic acid, just to be sure that I keep my homocysteine levels low, but I don’t want to add another pill to the six I take already (for blood pressure, high cholesterol, and arthritis pain). I’m 59 years old and to the best of my knowledge, I’ve never even had my homocysteine levels checked. Should I ask the doctor to do that at my next visit, and should I be taking folic acid daily? Charleston, South Carolina
A. Homocysteine is substance that we all produce from an amino acid (a building block of protein) in food. In the normal course of events, the homocysteine that healthy people manufacture is converted into amino acids that do them no harm. If the conversion does not take place rapidly enough, due to a genetic defect or vitamin deficiency (notably the B vitamins B6, B12, and folic acid), elevated levels of homocysteine may damage arterial walls and promote the buildup of cholesterol, potentially leading to arterial blockage and a heart attack.
However, while elevated levels of homocysteine have been shown to be a risk factor for heart disease, it still has not been proven that lowering homocysteine reduces the risk of CHD or heart attacks. Some doctors check homocysteine levels in patients with a strong family history of heart disease. But the American Heart Association does not recommend taking folic acid or other B vitamins to lower CHD risk.
