Homocysteine

What is homocysteine?
Homocysteine is an amino acid found in blood, produced as your body breaks down protein. Everyone has homocysteine in his/her blood, but some individuals have higher than normal levels. An individuals genetically determined body chemistry is usually the reason for elevated levels of homocysteine. High levels of homocysteine may damage the inner lining of your arteries and contribute to atherosclerosis (also know as hardening of the arteries) and the formation of blood clots. Atherosclerosis causes blockages of blood vessels and is the leading cause of heart disease and stroke. Homocysteine has been identified as a potential independent risk factor for early onset of atherosclerosis. In other words, an elevated homocysteine level may put you at risk for heart disease and stroke even if you do not have other risk factors such a high cholesterol, smoking, hypertension, diabetes or sedentary lifestyle. (Early onset" means the occurrence of heart attack or stroke at a much younger age that what is usually expected, namely before the age of 55 years in men and 65 years in women). The effects of an elevated homocysteine are well established in experimental and scientific studies. However, to date, there is no outcome study (i.e. placebo controlled, treatment trial) to show that lowering homocysteine will definitively decrease your future risk for cardiovascular disease: these studies are currently underway. Despite the lack of conclusive clinical trials, we believe there is sufficient evidence to support the treatment for elevated homocysteine. The treatment is very low risk and inexpensive, and there is a definite potential for benefit.

Who should have their homocysteine level checked?

Not everyone needs to have their homocysteine level checked. At this time, we recommend that individuals who have a history of heart attack, stroke, or other vascular diseases or history of blood clots at a relatively young age, that is before the age of 60. Individuals who are healthy but have a strong family history of these cardiovascular diseases in first degree relatives (for example, mother, father, siblings or offspring), particularly when these events occur in male relatives age 55 years or less, or female relatives age 65 years or less, should also have their homocysteine level assessed. If you have an elevated homocysteine, we would recommend that your siblings and children also have their homocysteine level checked.

This information is not intended to replace the advice of you physician. This information is provided to you by the Healthy Heart Program, St. Pauls Hospital, Vancouver, British Columbia

What can I do about my elevated homocysteine?

Your body normally gets rid of excess homocysteine by several pathways: folic acid (also know as folate) and vitamin B12 and vitamin B6 will help these pathways to work more effectively. The exact dose of vitamins needed to lower homocysteine is unknown at this time, although for several years we have used various combinations of vitamins and have found them to be both safe and effective in lowering homocysteine. In order to reduce your level of homocysteine, we recommend that you take daily:

Folic Acid 2mg available in the strength of 1mg tablets without a prescription at any pharmacy Vitamin B12 500mcg (0.5mg) available at most health food stores and pharmacies
These vitamins may be taken at any time during the day, and are generally well tolerated with very few side effects. If these vitamins are not effective in lowering your homocysteine, the addition of vitamin B6 or a change in the dosage of folic acid may be tried.

How often should I have my homocysteine checked?

You should have your homocysteine re-checked approximately 6 weeks after starting the folic acid and vitamin B12. After we receive the result of your repeat homocysteine level, we will contact you if a change in treatment is required. After your homocysteine level is reduced, it is important to continue to take the vitamin supplements. We recommend that your homocysteine level be assessed every 1 2 years. If you stop taking the folic acid and/or B vitamins, your homocysteine level will return again to a higher level.