InTouch Magazine - Spring/Summer 2002

Homocysteine... Another Risk Factor for Heart Disease?

There are a number of established modifiable and non-modifiable factors related to the risk of developing cardiovascular disease. The difference between individuals with and without cardiovascular disease may be explained by emerging risk factors identified through recent scientific research. One factor under consideration is homocysteine, an amino acid found normally in the bloodstream. The current list of established risk factors have been proven to speed up the development of heart disease, while emerging risk factors, like homocysteine, are less clear.

The National Heart, Lung, and Blood Institute (NHLBI) reviewed the scientific evidence regarding homocysteine's possible link to heart disease, stroke, and peripheral vascular disease. Though more research is essential to understand how homocysteine affects the progression of cardiovascular disease, the NHLBI concluded that an elevated level appears to raise the risk of cardiovascular disease. One possible theory scientists have developed is that homocysteine may be involved in the formation of fatty blockages, blood clots, and narrowing of blood vessels. All can cause a heart attack or stroke.

Homocysteine levels are strongly influenced by dietary intake and genetic defects. Folic acid, vitamins B-6 and B-12 break down homocysteine in the body. Deficiencies of these vitamins may cause an elevated level. Genetic defects of homocysteine metabolism may result in an elevated level, though these conditions are rare.

Research has not been completed proving that folic acid supplements reduce the risk of cardiovascular disease. The American Heart Association does not suggest the use of folic acid and B vitamins to treat or reduce the risk of heart disease and stroke at this time. Instead, they recommend a well-balanced diet including five servings of fruits and vegetables each day. Supplements should only be used when the diet is insuficient in one or more food groups.

Homocysteine screening is not advised for the general population. Because it is costly, not covered by insurance, and is not available at all medical centers, only those with a significant personal or family history, with no other risk factors should consider being tested. For now, health professionals advise monitoring those risk factors known to have devastating effects on the cardiovascular system. Concerns about homocysteine should be discussed with your physician. He or she will decide if you should be screened.

• Age. Your risk for all diseases increases with age, and heart disease is no exception. Nearly 4 out of 5 people who die of heart disease are 65 or older.
• Sex. Men are at the greatest risk in all age groups, however, after menopause, women are at the same risk as men.
• Race. African American and Native Americans are more at risk than Caucasian and Asian individuals.
• Family History. If a parent or sibling has experienced an early episode, your risk is higher.
• Personal History. If you have experienced a cardiac event in the past, your risk increases for future problems.

• Smoking. Smoking is the single most important behavior that increases your risk of heart disease. Smokers increase their risk of heart disease 2-4 times over those that don't. If you smoke, quit.
• High Blood Pressure. If your blood pressure readings are consistently 140/90 mm Hg or higher, you have hypertension. Individuals who are overweight, inactive, drink too much alcohol, smoke, stressed, or have poor dietary habits may need to make lifestyle modifications.
• High Blood Cholesterol. Total cholesterol should be less than 200 mg/dL Any reading above 240 mg/dL is considered high and nearly doubles the risk of a heart attack. Individuals with poor dietary habits, activity patterns, and who are overweight tend to have elevated blood cholesterol levels.
• Inactivity. Inactive people are twice as likely as active people to develop heart disease.Health professionals recommend at least 30 minutes of aerobic activity on most days of the week.
• Obesity. Obesity is defined as being over 30% of the recommended weight. Overweight and obese individuals tend to have higher blood pressure and elevated cholesterol.
• Diabetes Mellitus. Diabetics do not produce enough insulin, or the insulin they produce is not effective in moving sugar to the cells. Low levels of insulin raises triglyceride levels, which promotes fatty buildup in the arteries. If you have diabetes, monitor your blood sugars carefully.

• Stress. When you are under a lot of stress, you are more likely to maintain or pick up unhealthy lifestyles such as drinking, overeating, or smoking. Stress can also lead to high blood pressure.
• Alcohol. Alcohol restricts blood flow to the heart. Excessive alcohol consumption (more than 1-2 drinks daily) can raise blood pressure, blood sugar, and triglyceride levels.

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