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Several studies have shown that high homocysteine is associated with a higher risk for coronary heart disease development. This article outlines the connection between the two and ways to prevent high homocysteine levels.

If you are at a risk of developing heart disease, it is really important to recognize what you can change in your life to lower that risk. For many, that includes changing your diet, exercising more, quitting smoking, and losing weight. One of the lesser known risk factors for heart disease is having high levels of a molecule known as homocysteine in your blood.

What is homocysteine?

Homocysteine is a type of amino acid that is present in your blood stream. Amino acids are essentially building blocks the body uses to make proteins. There are several different types of amino acids in your blood, one of which is homocysteine. The normal amount of homocysteine in your blood is less than 15 micromoles per liter and any amount above 15 micromoles per liter is categorized as high. Usually, high homocysteine levels are indicative of a deficiency in vitamin B12 or folate.

How will I know if I have high homocysteine levels?

If a doctor suspects that you have high homocysteine levels, they will perform a simple blood test to verify their suspicions. In some cases, your doctor may ask you to fast before the test, as certain medicines and vitamin supplements can affect the results. You should talk to your doctor before you take the test and ask him or her what supplements to refrain from.

So, how does having high levels of homocysteine affect my risk of heart disease?

Several studies have shown that high levels of homocysteine are associated with an increased risk of having a heart attack or stroke. In particular, high levels of homocysteine are associated with a higher risk of heart attack or stroke at an earlier age. Additionally, people who genetically have higher levels of homocysteine are known to develop disease of the blood vessels (vascular disease) earlier on.

How does homocysteine increase your risk of heart disease?

While researchers are not sure exactly how high homocysteine levels increase your risk of heart disease, the theory behind the association is that homocysteine damages the cells that line your blood vessels. This, in turn, increases the risk of both blood clot formation and atherosclerosis (hardening and narrowing of arteries), which can lead to a blockage of the blood vessel and cause a heart attack.

There is a significant relationship between high homocysteine levels and damage to the arteries (which carry blood from the heart all over the body). Unfortunately, the exact role of homocysteine isn't yet known, and some researchers believe that homocysteine may just be a marker of heart disease rather than actually causing or worsening the condition.

Should I get my homocysteine levels checked?

Currently, there is no recommendation to get your homocysteine levels checked, even if you are at a risk of developing heart disease. Additionally, the test is quite expensive, usually not covered by insurance, and is not available everywhere. Thus, at this point, you do not need to get your homocysteine levels checked.

Can I prevent high homocysteine levels?

There are some ways to reduce your risk of having high blood homocysteine levels. These include:

  • Vitamin supplements. High homocysteine levels are associated with low levels of specific vitamins including vitamins B6, B12, and folate. Homocysteine levels are responsive to vitamins. Research has shown that supplements for folic acid and vitamin B12 can decrease in homocysteine levels by 25 percent. While researchers used to believe that lowering homocysteine levels using vitamins could help reduce the risk of heart disease and stroke, a large scale analysis of all the studies that have been conducted so far showed that reducing homocysteine levels with vitamins does not lead to a significant decrease in the risk of heart disease, stroke, or death. This has led researchers to believe that homocysteine may not lead to atherosclerosis but actually just be a marker of other risk factors or of heart disease itself. Additionally, you should be careful with taking vitamin B12 supplements as they have been shown to be associated with its own side effects.
  • Changing your diet. Homocysteine is primarily obtained through the meat we eat. Thus, reducing your red meat intake could lead to a reduction in homocysteine levels. As high red meat consumption is associated with a variety of diseases, including heart disease, you should try to reduce your meat consumption as much as you can. You can also increase your vitamin B and folate consumption by eating foods high in these vitamins, including green vegetables, orange juice, and beans. 

Future directions

At the moment, it is really not very well known whether lowering your homocysteine levels will actually prevent heart disease and stroke. Currently, there are several large clinical trials underway that are looking at this exact association in order to better determine whether reducing homocysteine levels through vitamin B supplementation can help reduce your risk of heart disease. Until this research has been conducted, physicians don’t recommend vitamin B supplements as the risks associated with vitamin B supplements may outweigh the benefits.

  • Homocysteine Studies Collaboration. (2002). Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. Jama, 288(16), 2015-2022.
  • Humphrey, L. L., Fu, R., Rogers, K., Freeman, M., & Helfand, M. (2008, November). Homocysteine level and coronary heart disease incidence: a systematic review and meta-analysis. In Mayo Clinic Proceedings (Vol. 83, No. 11, pp. 1203-1212). Elsevier.
  • Graham, I. M., Daly, L. E., Refsum, H. M., Robinson, K., Brattström, L. E., Ueland, P. M., ... & Uiterwaal, C. S. (1997). Plasma homocysteine as a risk factor for vascular disease: the European Concerted Action Project. Jama, 277(22), 1775-1781.
  • Photo courtesy of SteadyHealth

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