By: Laurie Edwards for Heart1In the world of heart disease and stroke, there are a few axioms conventional wisdom upholds. A healthy diet is important for cardiovascular health. Regular exercise is recommended to help lower the risk of heart attack and stroke. A vitamin B regimen is a safe and effective way to decrease the likelihood of cardiovascular events.
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Helping Your Heart
Before you start or stop a vitamin regimen, consult with your physician.
Vitamins aside, other ways to maintain good heart health include:
A healthy diet
Regular exercise
Monitoring your cholesterol levels
An estimated 35 percent of Americans take vitamins as a preventative therapy.
B vitamins reduce homocysteine levels, an amino acid linked to heart disease and stroke.
Recent studies suggest that despite lowering homocysteine levels, B vitamins do not prevent cardiovascular events.
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But in light of recent studies, experts are questioning if taking B vitamins – folic acid, vitamin B12 and vitamin B6 – is really beneficial for those patients at high risk. And in extrapolating the results to a more general population, some also wonder if a B vitamin regimen is worth it for healthier patients as well.“Every intervention that works in sick people also works in less sick people: Cholesterol lowering, blood pressure lowering. And things that don’t work in sick people don’t work in less sick people either,” said Dr. Salim Yusuf of Ontario’s McMaster University, an author of one of the studies, two of which were published in a recent issue of The New England Journal of Medicine.
The third study was published in 2004 in the Journal of the American Medical Association.
An estimated 35 percent of Americans take B vitamins. They reduce homocysteine, an amino acid associated with higher risk of cardiovascular health. As such, many believe the protective aspect of B vitamins is as important to heart health as the statin drugs many patients take to lower cholesterol.
In fact, though they did find a small decrease in reported stroke, researchers found that patients taking all three supplements at once actually faced a slightly increased risk of heart attack.
“Such therapy may even be harmful after acute myocardial infarction or coronary stenting and should therefore not be recommended,” wrote the authors of the study published in JAMA.
Together, all three studies followed more than 9,000 high-risk patients to test the homocysteine hypothesis. While taking the vitamins did lower homocysteine levels by one-third in patients, the numbers of heart attack and stroke for these patients remained about the same as they were for those on placebos.
In an editorial accompanying the studies in the New England Journal of Medicine, Dr. Joseph Loscalzo of Boston’s Brigham and Women’s Hospital wrote, “The consistency among the results leads to the unequivocal conclusion that there is no clinical benefit of the use of folic acid and vitamin B12 (with or without vitamin B6) in patients with established vascular disease.”
Not everyone is prepared to write off the vitamin regimen so quickly. “These studies did not test whether B vitamins used by healthy people can help keep them healthy. Instead, they looked at whether B vitamins can treat or reverse heart disease in people who already have it. Vitamins should not be expected to perform like drugs – their greatest purpose is prevention,” said Anne Dickinson, a consultant and past president of the Council for Responsible Nutrition, an organization that represents the supplements industry.
Another way of looking at the situation is that it’s not that lowering homocysteine doesn’t prevent heart attacks, but perhaps that vitamin therapy is not the best way to lower homocysteine. Or, as Dr. Yusuf suggests, it could be that higher homocysteine levels aren’t the cause of heart disease or stroke but are a symptom of it, much in the same way a fever is a sign of infection.
These findings point to the need for further research into the role of homocysteine in heart health and the most effective ways to lower it.
