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FRAMINGHAM, MASSACHUSETTS. Congestive heart failure (CHF) is a serious health problem among the
elderly. The main risk factors are advancing age, high blood pressure (hypertension), diabetes, obesity,
heart valve disease, and having experienced a heart attack. Researchers involved with the Framingham
Heart Study now report that a high blood level of homocysteine, a sulfur-containing amino acid, is an
independent risk factor for CHF. Their study involved 1547 women and 944 men between the ages of 60
and 95 years. All participants were free of CHF and had not suffered a heart attack at the start of the study.
After 8 years of follow-up 156 (6.2%) participants (88 women) had developed CHF. The researchers found
that women in the highest quartile of homocysteine level (13.7 – 64.6 micromol/L) had a 4 times higher risk
of CHF than did those in the lowest quartile (3.5 – 8.9 micromol/L). Even women with only slightly elevated
homocysteine levels (9.0 – 11.0) had twice the risk of women in the lowest quartile. The risk for men in the
highest quartile (14.5 – 219.8 micromol/L) was 50% higher than for men in the lowest quartile (4.1 – 9.5
micromol/L); however, a significant increase was not observed until the level exceeded 11.8 micromol/L.
The risk estimates are those obtained after adjusting for age, smoking, valve disease, systolic blood
pressure, antihypertensive medication use, echocardiographic left ventricular hypertrophy, diabetes, ratio of
total cholesterol to high-density lipoprotein, alcohol intake, body mass index, serum creatinine, interim
recognized or unrecognized myocardial infarction, and baseline examination.
The researchers urge further trials to determine if reducing elevated homocysteine levels through
supplementation with folic acid, vitamin B6 and vitamins B12 will reduce the risk of CHF. Editor's comment: Homocysteine levels can be safely and effectively lowered by daily supplementation with 400-800 micrograms of folic acid, 50-100 mg of vitamin-B6 (pyridoxine) and 1 mg of vitamin-B12 (cyanocobalamin) taken sublingually.
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