DON’T EAT YOUR HEART OUT  
   
Besides common risk factors (such as smoking, excess weight, high cholesterol and lack of exercise) for coronary heart disease, many are still in the dark of another risk factor that can be just as important. Elevated levels of homocysteine can be associated with heart disease and stroke as Caroline J. Dawson-Elias discovers.
  
   

HOMOCYSTEINE FACTS
Pronounced as 'Ho-mo-SIS-teen', homocysteine is an amino acid that is produced as the body metabolises protein. High levels may irritate blood vessels, thus damaging arterial vessels and initiating the inflammatory processes that eventually result in blockage. Too much homocysteine in the blood has been found to be associated with increased risk of heart disease, stroke and blood vessel disease.

According to a 1997 study reported in lAMA, (The Journal of the American Medical Association) an increased homocysteine level presents an independent risk of cardiovascular disease similar to that of high cholesterol or smoking. Earlier studies reported in the same journal revealed that males with the highest homocysteine levels were three times more likely to suffer a heart attack, even when taking other risk factors into account.

Other possible causes of high homocysteine levels include kidney disease, low levels of thyroid hormone and hereditary deficiencies in the enzymes, which are vital in processing homocysteine in the body.

MEASURING HOMOCYSTEINE LEVEL
The American Heart Association suggests homocysteine measurements for individuals with a family history of cardiovascular disease. We can now measure the level of homocysteine using a simple blood test and fasting is not required. It can also be measured any time of the day.

Take note that a healthy homocysteine level is less than 12 millmol per L. If your homocysteine level is between 12 to 15 millmol per L, you need to lower your homocysteine to less than 12 millmol per L especially if you experience blockages in any blood vessel.

The good news however is that you are allowed to maintain a high homocysteine level (12 to 15 millmol per L) if you have no risk factors for cardiovascular disease and if you do not have atherosclerosis.

Although there are no conclusive studies proving that homocysteine level helps to reduce heart attacks and strokes, it is ultimately advisable to lower a high homocysteine level because it is a clearly established risk factor for heart disease. In addition, testing for elevated homocysteine could provide an early warning of cardiovascular disease and thereby allowing one to take preventive measures such as having a well-balanced diet.

LOWERING HOMOCYSTEINE LEVEL
High levels of homocysteine are caused by lack of vitamin Bs or enzymes, which help to process homocysteine. Such individuals are also typically not consuming enough folic acid. However, since homocysteine levels in the blood are strongly influenced by diet, foods rich in folic and Vitamin B6 & B 12 should be eaten regularly to help break down homocysteine in the body. High levels of these nutrients in the diet appear to be associated with low levels of homocysteine in the blood.

Therefore, consume foods rich in folic acid such as fruits and vegetables (leafy green ones like spinach). Others include lentils, asparagus, chickpeas, most beans and breakfast cereals.

If however, you find that adjusting your diet is still not enough to lower your homocysteine level, take specific vitamins. Insist on checking with your doctor first before trying for higher doses.

QUICK ANSWERS TO FAQs

1) How does the body regulate homocysteine?
  Excess homocysteine is rapidly eliminated under normal circumstances. With the aid of essential vitamins, the liver converts the homocysteine into an amino acid for the body to break down for excretion.
   
2) Does homocysteine increase the risk of a heart attack?
  Only high levels of homocysteine may contribute to the arterial wall injury produced by other substances such as cholesterol. As a result, the damaged arteries would likely narrow or close completely.
   
3) Should I get my homocysteine level tested?
  The American Heart Association suggests homocysteine measurements for individuals with a family history of cardiovascular disease.
   
4) How do I check my homocysteine level?
  You should discuss with your doctor as the test can be administered easily in the course of running a normal blood test.
   
5) What causes high levels of homocysteine?
  It may result from a deficiency of certain important vitamins. There are some people who have a mild genetic defect in the pathway of homocysteine metabolism. Such individuals should thus consume foods rich in folic acid, vitamin B6 and vitamin B12.
   
6) Can I control my homocysteine level?
  Yes, in most cases, it is easy to control elevated levels of homocysteine. Insist on having a well-balanced diet which includes citrus fruits, meats, leafy vegetables, beans, fish and fortified grains and cereals. It is advisable to discuss your diet with your doctor.

(This article first appeared in Parkway Medicine, April 2002)