Folic Acid Supplementation in Patients with Elevated Homocysteine Levels
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REVIEW
Folic Acid Supplementation in Patients with Elevated Homocysteine Levels Alan D. Kaye . George M. Jeha . Alex D. Pham . Mitchell C. Fuller . Zachary I. Lerner . Gerald T. Sibley . Elyse M. Cornett . Ivan Urits . Omar Viswanath . Christopher G. Kevil
Received: July 9, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: Folic acid is the most important dietary determinant of homocysteine (Hcy). Hcy serves as a critical intermediate in methylation reactions. It is created from methionine and either converted back to methionine or transformed into cysteine. This process is aided through several enzymes and three vitamins,
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folic acid, B12, and B6. Daily supplementation with 0.5–5.0 mg of folic acid typically lowers plasma Hcy levels by approximately 25%. Hyperhomocysteinemia is a known risk factor for coronary artery disease. In this regard, elevated levels of Hcy have been found in a majority of patients with vascular disease. Methods: A literature review of folic acid supplementation for various disease states including cardiovascular disease was conducted. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.
A. D. Kaye Department of Pharmacology, Toxicology, and Neuroscience, LSU Health Shreveport, Shreveport, LA, USA
I. Urits Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
G. M. Jeha Department of Anesthesiology, LSU School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA
O. Viswanath Valley Pain Consultants–Envision Physician Services, Phoenix, AZ, USA
A. D. Pham Z. I. Lerner G. T. Sibley Department of Anesthesiology, LSU Health New Orleans, New Orleans, LA, USA M. C. Fuller Medical College of Wisconsin, Wauwatosa, WI, USA E. M. Cornett (&) O. Viswanath Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA e-mail: [email protected]
O. Viswanath Department of Anesthesiology, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA O. Viswanath Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA C. G. Kevil Department of Pathology, LSU Health Shreveport, Shreveport, LA, USA
Adv Ther
Results: In this review, we discuss the biochemistry of folic acid, Hcy biosynthesis, Hcy and hydrogen sulfide bioavailability, pathogenesis of hyperhomocysteinemia and its role as a risk factor for disease, and treatment studies with folic acid supplementation in disease states. Conclusion: Folic acid supplementation should be recommended to any patient who has an elevated Hcy level, and this level should be measured and treated at an early age, since folic acid is easily obtained and may likely
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