Use Folic Acid to Cut Heart Disease, Say Experts

The scientific evidence is strong enough to justify using folic acid as a cheap and simple way of reducing heart disease and strokes, say researchers in this week’s BMJ. Debate continues over whether raised homocysteine levels in the blood (an amino acid implicated in the development of arterial disease) causes heart disease and stroke, and whether folic acid, which lowers homocysteine, will help reduce the risk of these disorders.

So heart expert, Dr David Wald and colleagues set out to clarify the issue. They examined all the evidence from different studies to see whether raised homocysteine is a cause of cardiovascular disease.

Some studies looked at homocysteine and the occurrence of heart attacks and strokes in large numbers of people (cohort studies), some focused on people with a common genetic variant which increases homocysteine levels to a small extent (genetic studies), while others tested the effects of lowering homocysteine levels (randomised controlled trials).

The cohort studies and genetic studies yielded similar results, indicating a protective effect from lower homocysteine levels, even though they did not share the same sources of possible error. The randomised trials were too small to be conclusive although their results were consistent with the expected protective effects of folic acid.

The conclusion that homocysteine is a cause of cardiovascular disease explains the observations from all the different types of study, even if the results from one type of study are, on their own, insufficient to reach that conclusion, say the authors.
Since folic acid reduces homocysteine concentrations, it follows that increasing folic acid consumption will reduce the risk of heart attack and stroke.

They therefore take the view that the evidence is now sufficient to justify action on lowering homocysteine concentrations, although the position should be reviewed as evidence from ongoing clinical trials emerges.

BMJ Volume 333 pp 1114-7 Click here to view paper: https://press.psprings.co.uk/bmj/november/ac1114.pdf

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FACT:
Metformin Beneficial for Obese and Non-Obese Patients with Diabetes: The diabetes drug metformin is at least as effective in normal and overweight patients as it is in obese patients, according to a report in the journal Diabetes Care. Although metformin is a first-line therapy for obese patients with type 2 diabetes, the authors point out, there is little information about the effectiveness of metformin in patients who are not obese. Researchers used a database to compare the long-term outcomes of metformin therapy in 644 type 2 diabetics who were normal weight, overweight or obese. Metformin provided comparable long-term control of blood sugar levels in obese and non-obese patients, the report indicates. Moreover, it was just as effective in both groups at preventing diabetes complications. Obese patients lost more weight than did nonobese patients on metformin, the researchers note, but patients who were not obese at the beginning of the study remained thinner throughout follow-up than those who started out obese. The patients who weren’t obese were able to maintain their glucose levels without requiring other drugs for a longer duration than obese patients. "Metformin is at least as efficacious in the nonobese as it is in the obese," the authors conclude. "This study provides evidence-based data to support metformin use in nonobese individuals who have type 2 diabetes." Diabetes Care, November 2006.