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"Supplementation
of folic acid, vitamins B6 and B12 may help people with HIV to reduce increased
homocysteine levels and the risk of developing heart disease."
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Homocysteine
And Heart Disease
Homocysteine (Hcy) is
an amino acid and a product of the metabolism of methionine. Low blood
levels of folic acid, vitamins B6 and B12 can lead to the accumulation
of homocysteine in the blood. Of relevance to people with HIV, elevated
plasma homocysteine levels are associated with poor cognition and dementia
(see the Nov/Dec 1996 HIV ReSource Review feature article). (1) Also, numerous
HIV-positive people on HAART are experiencing heart disease as a medication
side effect. Studies show that plasma homocysteine level is an important
risk factor that predicts cardiovascular disease. (2-4)
Numerous researchers have
studied the effect of supplementation on homocysteine levels. Hirsch and
colleagues saw increased serum folate levels and decreased homocysteine
levels in a small group of elderly people enrolled in a flour fortification
program. (5) Quinlivan and colleagues suggest that fortification of food
with both folic acid and vitamin B12 is likely to be much more effective
at lowering homocysteine concentrations than folic acid alone. (6)
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Hyperhomocysteinemia influences
restenosis rate after percutaneous coronary intervention (PCI). A group
of investigators led by Guido Schnyder, MD, found that the incidence of
major adverse events after PCI was significantly decreased due to the use
of homocysteine-lowering therapy with folic acid, vitamin B12, and vitamin
B6. (7,8) The six month randomized, double-blind trial recruited participants
who were randomly assigned to receive either a daily dose of 1 mg folic
acid, 400 µg cyanocobalamin (vitamin B12), and 10 mg pyridoxine hydrochloride
(vitamin B6) or a placebo (n= 281). Participants in the treatment group
(n= 272) displayed a significantly decreased incidence of major cardiac
events after angioplasty even after the researchers adjusted their data
taking into account potential confounders.
Since HIV-positive people
are more likely to have nutritional deficiencies including deficiencies
of the B vitamins, supplements may help to lessen the occurrence of heart
disease. The cost-benefit ratio of treating Americans with folate and vitamin
B12 (and B6) to lower homocysteine levels could be cost-effective compared
with drug treatment. (9) Supplementation of folic acid, vitamins B6 and
B12 may help people with HIV to reduce increased homocysteine levels
and the risk of developing heart disease.
For additional information
on homocysteine see:
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