IHN Database

Congestive heart failure and homocysteine

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.
Vasan, Ramachandran S., et al. Plasma homocysteine and risk for congestive heart failure in adults without prior myocardial infarction. Journal of the American Medical Association, Vol. 289, March 12, 2003, pp. 1251-57

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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