HOMOCYSTEINE

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

What do Smashing Pumpkins, Mother Theresa, Topher Grace and the Dauphin Clinic Pharmacy have in common? 1979. It was a hit song off of the Smashing Pumpkins album Mellon Collie and the Infinite Sadness. It was the year Mother Theresa won the Nobel Peace Prize. The TV Comedy "That 70's Show" that Topher Grace starred in had its last episode set December 31, 1979. Finally, the Dauphin Clinic Pharmacy was opened in 1979 by Mr. Myles Haverluck.
Think of all the things that have changed since 1979. Just today I wrote this article on a personal computer, looked up some information on Google, phoned home on my cell phone, checked my email, tele-commuted to the store in Winnipegosis and played around with Skype Video-conferencing. None of those everyday things existed or were even dreamed of in 1979. Since so many things in our everyday lives seem to be constantly changing, it shouldn't be a surprise that medical knowledge and information is always changing too. Take homocysteine. Homocysteine is an amino acid with some interesting stories to tell.
It was noticed that children with a genetic metabolic condition that gave them high homocysteine levels also got damaged blood vessels more often than we would normally expect. The scientists thought that high homocysteine levels damaged the lining of the blood vessels call the endothelieum and made blood clot more than normal. We think that many people with athererosclerosis or hardening of the arteries also have high homocysteine. We also know that if we give people B vitamins and folic acid we can reduce their homocysteine levels. The big question is if we give people high doses of B vitamins and folic acid will they have fewer heart attacks and strokes and die less often?
Well, there was a big trial in 2005 with 3749 people in it called NORVIT or the Norwegian Vitamin Trial. They gave people who had had a heart attack in the last 7 days folic acid, folic acid plus vitamin B6 or a placebo. The homocysteine levels in the folic acid groups went down. They found no change in risk of heart disease with or without the folic acid and vitamin B6. The actually found an increase in risk of heart attack in the people on high doses of Vitamin B6 and folic acid.
One reason people like me were so excited about homocysteine was that it was so easy to treat. We have good medications to reduce cholesterol called statins. We believe that if we reduce a person's cholesterol with a statin, we will reduce the chance of heart attack and stroke. Many studies have backed this up. Some of the downsides to statins is they are relatively expensive and they can cause side effects in a small number of people. If reducing someone's homocysteine reduced their chance of heart attack and stroke, that would be great because we can reduce homocysteine with B vitamins and folic acid. They are relatively inexpensive, available without a prescription and relatively free of side effects.
But the homocysteine story is a bust, right? The big NORVIT study found no benefit, right? Well the homocysteine story continues to evolve. While it is unlikely that we will recommend everyone go on folic acid and B Vitamins to reduce their homocysteine, there may be some populations that could benefit from folic acid. In an Israeli study published in the American Journal of Cardiology in September 2009 found people with early onset coronary arteries disease and who had high homocysteine levels did benefit from folic acid and B vitamins. It was a smaller study with only 492 patients in it, but the folic acid/B vitamin group did die less often. Remember, though, this was a very specific group of people with the heart condition early onset CAD and who had high homocysteine levels. So the homocysteine story continues.
So what is the take home message for most of us? Whole grains and dark green leafy vegetables. This is where B Vitamins and folic acid come from in our diet. Eat more of them. They do lots of good things for you including lowering your homocysteine levels. Today we can't say that lowering your homocysteine levels will help your heart, but the story continues to evolve. Just like the original UseNet experiments in 1979 developed into a part of the internet we enjoy today and the Dauphin Clinic Pharmacy grew from a tiny one man operation to arguably one of the best pharmacies in Canada, it will be interesting to see where the homocysteine story goes.

As always if you have any questions or concerns about these or other products, ask your pharmacist.