Drugs & Aging

, Volume 23, Issue 6, pp 491–502 | Cite as

Homocysteine Lowering with Folic Acid and Vitamin B Supplements

Effects on Cardiovascular Disease in Older Adults
Review Article

Abstract

Cardiovascular disease (CVD) is the leading cause of death in older men and women and contributes significantly to morbidity in later life. Folic acid and other vitamin B deficiencies and elevated total plasma homocysteine levels are associated with increased cardiovascular risk in geriatric patients, but recent studies have questioned the importance of these risk factors in older people. Data on the effects of homocysteine-lowering therapy (e.g. folic acid and vitamin B supplements) on surrogate CVD endpoints, such as atherosclerotic progression, endothelial function, inflammation and hypercoagulation, are conflicting. Findings from randomised clinical trials using clinical CVD outcomes show that folic acid and vitamin B supplements may not provide cardiovascular protection. Furthermore, these findings raise questions about whether the combination of folic acid and B vitamins may actually be harmful. Other large randomised clinical trials are underway to help clarify the role of folic acid and vitamin B supplements in CVD prevention in older people. Data to date do not support use of homocysteine-lowering therapies in either middle-aged or older adults.

Notes

Acknowledgements

The author was supported in part through the Beeson Career Development Award (1K23 AG026752–01), a grant jointly funded by the National Institute on Aging, the John A. Hartford Foundation, Atlantic Philanthropies and the Starr Foundation. The author has no conflicts of interest relevant to the contents of this review.

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Authors and Affiliations

  1. 1.Department of Medicine, Section of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Department of Veterans Affairs (VA) Geriatric ResearchEducation and Clinical Center (GRECC)MadisonUSA

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