NEJM study says B-vitamins do not prevent death from cardiovascular causes

In response to the New England Journal of Medicine's study on B-vitamins lowering homocysteine, we have some thoughts. This study will, of course, raise some eyebrows, but once again, we need to look at the fine print before making a judgement call. The conculsion of the study reads:

Supplements combining folic acid and vitamins B₆ and B₁₂ did not reduce the risk of major cardiovascular events in patients with vascular disease. (ClinicalTrials.gov number, NCT00106886; Current Controlled Trials number, ISRCTN14017017.).

Now let's break it down:

The study did show that B-vitmains vitamins help lower homocysteine levels, but failed to support the hypothesis that lowering homocysteine levels in persons who already have heart disease will not provide protection against a future cardiac event. While these studies contribute importantly to the research base, they have limited application for the general population. These studies did not test whether B vitamins used by healthy people can help keep them healthy. Instead, they looked at whether B vitamins can treat or reverse heart disease in people who already have it. Vitamins should not be expected to perform like drugs—their greatest promise is in prevention.

It is unrealistic to expect a vitamin to undo damage caused by heart disease and we should not be looking for B-vitamins to treat disease. Both these studies involved seriously ill subjects (eerily similar to the reserach published on vitamin E). But what must be considered, is whether the population studied would have been healthier to begin with if they had been taking B-vitamins and others consistently over time. That’s the question we’d like to see researched!

The HOPE-2 study did have some positive findings, including a statistically significant 25% reduction in nonfatal strokes. The authors say this may be due to chance, but similar effects have also been observed in other studies (see below).

So what we can get from this study is that B-vitmains do lower homocysteine, which can also assist in preventing several other maladies as seen below from our archive.

Excerpts courtesy of the Council of Responsible Nutrition

B vitamins to lower homocysteine may prevent strokes
Taking high doses of B vitamins may help reduce the risk of a second stroke and heart attacks, according to a new analysis. The B vitamin group, including folic acid, B6, and B12, reduce the amount of the amino acid homocysteine in the blood. High levels of this substance have been linked to heart disease. In a new analysis they excluded patients with low and very high B12 levels at baseline. These were likely to have B12 malabsorption or to be taking B12 supplements outside the study. In the remaining 2155 patients, high-dose vitamin supplements reduced recurrent stroke, death and heart disease by 21 per cent compared with those taking low-dose vitamins, they report in the 2005, 1 November issue of Stroke (vol 36, p2404).The authors suggest that given the fortification of flour with folate, the response to vitamin therapy for lowering homocysteine largely depends on B12 levels of heart patients. Higher doses of B12 could be required to reduce homocysteine, and thus to reduce stroke and heart attack.

B-Vitamin Deficiency May Cause Depression -
Experts say that some people with depression may have an inability to metabolize the B-vitamin folate, intimating that folic acid supplementation may be warranted. Norwegian researchers found that those who had higher levels of homocysteine in their blood were twice as likely to be depressed. Homocysteine is a normal byproduct of metabolism, which folic acid breaks down. Abnormal homocysteine levels are also associated with heart disease and Alzheimer's. Archives of General Psychiatry 2003;60:618-626

Folic Acid/B12 Can Reduce Hip Fractures in Elderly -
According to a new Japanese study in this week's Journal of the American Medical Association, the risk of hip fracture is significantly higher in stroke patients than in other individuals of the same age, and is thought to be associated with increased blood levels of a substance called homocysteine. Because folate and mecobalamin (vitamin B12) reduce homocysteine levels, the team thought that supplements of these nutrients could reduce fracture risk. Colleagues studied 628 patients aged 65 years or more who had residual paralysis on one side of the body a year or more after having a stroke. The participants were randomly assigned to take folate and mecobalamin daily, or inactive placebos. During 2 years of follow-up, the number of falls in each group was virtually the same, but there were only six hip fractures in the supplement group compared with 27 in the placebo group. Even though homocysteine levels dropped in the active treatment group and rose in the placebo group, bone mineral density did not differ significantly between groups -- so that didn't explain the fewer number of fractures.

Folic Acid Reduces Cardiovascular Risk In Elderly -
Elderly people who take a daily supplement of folic acid may lower blood homocysteine levels, which are associated with cardiovascular risk. This is the first study to demonstrate its effect with the elderly. The researchers found that those supplementing with 400 mcg or 600 mcg daily, had a significant reduction in homocysteine levels. The results also suggest that a total folic acid intake (from food and supplements) of 900 to 1000 mcg per day is required to ensure 95% of the elderly population would be without cardiovascular risk from elevated homocysteine resulting from folic acid deficiency. Quarterly Journal of Medicine, 2002;95:27-35.

Journal of the American Diabetes Association 2002:
62nd Scientific Session Abstract Highlights
Increased homocysteine concentrations is associated with insulin resistance and endothelial dysfunction and supplementation with folic acid and vitamin B12 improves vascular endothelial function.

Low Plasma Vitamin B-6 Levels Correlate With Rheumatoid Arthritis -
"Patients with rheumatoid arthritis have low levels of plasma B-6 and elevated plasma homocysteine responses to a methionine load." says Tufts researchers. The study shows a correlation between low plasma pyridoxal 5'-phosphate (B6) and high Sed Rate and C-Reactive Protein levels (both markers that can determine the severity of a patients rheumatoid arthritis). Researchers believe that inability to break down B6 into P-5-P or simply not enough intake are to blame. Am J Med 2003;114:283-287

Lack of B-Vitamins May Contribute to Cognitive Decline -
High homocysteine concentrations in people over age 60 were associated with decreasing levels of cognitive performance. High vitamin B12 levels correlated with better cognitive performance. Am J Epidemiology, October 1, 2005