Written by Greg Arnold, DC, CSCS. Supplementing 400 mg of folic acid per day for 12 weeks resulted in an approximately 20 % decrease in homocysteine levels.

Atherosclerosis is defined by the American Heart Association as “the narrowing of the coronary arteries due to fatty buildups of plaque” (1). Research has shown that atherosclerosis is initiated by the presence of inflammation in blood vessels (2) marked by high levels of C-reactive protein (3). Atherosclerosis eventually leads to coronary heart disease, which caused 445,687 deaths in 2005. It is the single leading cause of death in America today (1) and costs our healthcare system $448 billion per year (4).

Now a new study (5) suggests folic acid may help those with risk factors for atherosclerosis. The study involved 124 Caucasian subjects (60 men, 64 women) between the ages of 20 and 39 with atherosclerosis risk factors (family history of stroke, high blood pressure, abnormal lipid levels (called dyslipidemia), overweight and obesity, cigarette smoking, and low-level of physical activity). They were given 400 micrograms of folic acid per day for 12 weeks (no control group), and had blood samples drawn before and after the study. The amount of folic acid given to the patients coincides exactly with the recommended daily allowance for males and females 14 years and older.

Twelve weeks of folic acid supplementation increased blood folic acid levels by 98.4% in females (6.3 to 12.5 nanograms/deciliter, p=0.001) and 78% in males (6.4 to 11.4 ng/dL (deciliter), p=0.001). It also decreased homocysteine levels by 21.7% in females (10.6 to 8.3 micormoles/liter, p=0.001 and 19.2% in males (11.5 to 9.3, p=0.001, respectively) which is important as homocysteine levels below 10 micromoles/liter is considered normal (6). Folic acid supplementation also decreased total cholesterol levels by 5.1% in females (203.4 to 193.1 milligrams/deciliter, p=0.001) and 3.7% in males (209.5 to 201.9; p=0.002), and LDL (low-density lipoprotein) cholesterol by 7% in females (107.4 to 99.9 mg/dL, p=0.001) and 5.3% in males (121.5 to 115.1 mg/dL, p=0.002, respectively).

While there was no statistically significant increase in high-density lipoprotein cholesterol, there was a 3.5% increase in the major component of high-density lipoprotein cholesterol, apoprotein A1, in men with a body mass index (BMI) > 25 kilograms/meters2 (140.0 to 145.0, p = 0.024) and a 2.1% increase in women smokers (154.3 to 157.6 mg/dL, p = 0.032)

The researchers caution that these results provide hope only for those at risk for atherosclerosis, not for those already with atherosclerosis/cardiovascular disease, citing 3 previous studies that found no benefit of folic acid supplementation for those with established cardiovascular disease (7, 8, 9). For the researchers, “low-dose folic acid supplementation has a beneficial effect on blood lipids through decreasing concentrations of to­tal cholesterol and low-density lipoprotein cholesterol and increasing concentrations of apoAI.”

Although this study found an important association between folic acid and lowered risk of cardiovascular disease, it did not have a control (comparison) group and therefore it is not possible to establish a definitive relationship. For future studies, a large placebo-controlled randomized trial will hold higher value in establishing the beneficial effect of folic acid on cardiovascular disease.

Source: Mierzecki, Artur, et al. “Association between low-dose folic acid supplementation and blood lipids concentrations in male and female subjects with atherosclerosis risk factors.” Medical Science Monitor 19 (2013): 733-739.

© Med Sci Monit, 2013; 19: 733-739 Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License

Posted January 20, 2014.

Greg Arnold is a Chiropractic Physician practicing in Hauppauge, NY. You can contact Dr. Arnold directly by emailing him at PitchingDoc@msn.com or visiting his web site at www.PitchingDoc.com

References:

  1. “Cardiovascular Disease Statistics” posted on American Heart Association Website.
  2. Packard RRS, Libby P. Inflammation in atherosclerosis: from vascular biology to biomarker discovery and risk prediction. Clin Chem 2008; 54:24-38.
  3. Mora S, Musunuru K, Blumenthal RS. The clinical utility of high-sensitivity C-reactive protein in cardiovascular disease and the potential implication of JUPITER on current practice guidelines . Clin Chem 2009 55: 219-228.
  4. “Cardiovascular Disease at a Glance” posted on the CDC website.
  5. Mierzecki A.  Association between low-dose folic acid supplementation and blood lipids concentrations in male and female subjects with atherosclerosis risk factors.  Med Sci Monit 2013 Sep 4;19:733-9. doi: 10.12659/MSM.889087.
  6. Lonn E, Yusuf S, Arnold MJ et al., The Heart Outcomes Prevention Evaluation (HOPE) 2 Investigators: Homocysteine lowering with folic acid and B vita­mins in vascular disease. N Engl J Med, 2006; 354: 1567–77.
  7. Lonn E, Yusuf S, Arnold MJ et al., The Heart Outcomes Prevention Evaluation (HOPE) 2 Investigators: Homocysteine lowering with folic acid and B vita­mins in vascular disease. N Engl J Med, 2006; 354: 1567–77.
  8. Bønaa KH, Njølstad I, Ueland PM et al: Homocysteine lowering and cardio­vascular events after acute myocardial infarction. N Engl J Med, 2006; 354: 1578–88.
  9. Toole JF, Malinow MR, Chambless LE et al: Lowering homocysteine in pa­tients with ischemic stroke to prevent recurrent stroke, myocardial infarc­tion, and death: the Vitamin Intervention for Stroke Prevention (VISP) ran­domised controlled trial. JAMA, 2004; 291: 565–75.