Q. Are There Any Interactions Between Vitamins and Heart Disease?
A. Possibly!

Many "risk factors" have been described for heart disease, including various fats, genetics, mycoplasma infection, high blood pressure, diabetes, and many more. Since there is no single cause of heart disease, we seek more 'risk factors' hoping some day to predict in whom it will occur, and to prevent it. Such an additional factor is "homcysteinemia" the accumulation of a toxic metabolic product of sulfur-containing amino acids.

Clotting in blood vessels is observed in patients with inherited genetic diseases which are associated with accumulation of homocysteine. In some people whose body stores of vitamin B12 and/or folate are lower than average, there is more homocysteine in the blood than in those with higher stores. In none of these people can one find other evidence that they do not have enough vitamin B12 or folate to keep them healthy. In some of these, giving excess folate and/or vitamin B12 will reduce the homocysteine in the blood.

Studies of populations have shown that there is more serious illness and death among people with the highest homocysteine in the blood than among those with lower concentrations. No one has yet shown however, that serious illness or heart disease in such population can be prevented by giving excess vitamins. Some patients who have had heart disease seem to have less risk of another heart attack when their elevated homocysteine levels are reduced.

Is there any risk to taking supplemental folate and vitamin B12?

Taking extra folate may be dangerous in persons who are becoming deficient in vitamin B12 (e.g. pernicious anemia), because of unrecognized irreversible nerve damage which can lead to paralysis. This can be prevented by also taking enough extra vitamin B12 even in patients in whom absorption is abnormal. Daily oral doses of folic acid of 0.4 mg with vitamin B12 of 1000 m g are safe and might lower homocysteine levels if they are elevated. These are available without prescription. Many foods in the US are now supplemented with folate for reasons other than this.

Is this a problem?

This is unknown in the general population, but there are certain persons with clotting disorders in whom homocysteinemia (too much homocysteine in the blood) aggravates or even causes the disorder.

Can you have your homocysteine level measured?

Yes, the test is available if you wish.

Should you take these supplemental vitamins?

There is no proof that this is useful. The data are summarized above. The choice is yours.