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Taking
a daily multivitamin or eating a bowl of fortified cereal each day
may be the most cost-effective way to ward off deadly heart trouble,
says a new study. It may not be the best way, but it could save
lives, the study says. That's because vitamins and fortified breakfast
cereals have folic acid, which cuts blood levels of an enzyme called
homocysteine, says the researchers.
Elevated
blood levels of homocysteine, which can promote blood clots and
atherosclerosis, may be linked to between 6 percent and 10 percent
of all heart deaths in America. However, the researchers say they
aren't sure of the figure, or how much a high homocysteine count
increases an individual's risk. However, heart experts believe that
reducing the enzyme, by taking vitamin supplements containing 400
milligrams of folic acid or eating foods such as cereals fortified
with the nutrient, may be relatively cheap ways to save lives.
In
the latest study, University of Michigan researchers sought to learn
how cost-effective a daily multivitamin might be. They designed
a computer model to predict the economic savings of vitamin regimens
with varying effectiveness at reducing homocysteine. Setting the
value of an average year of life at $50,000, the researchers found
that giving vitamin supplements to everybody middle-aged and older
would be cost-effective compared with doing nothing. But screening
people at risk of heart disease and treating only those with elevated
homocysteine proved to be the most efficient strategy, costing 60
percent less than the mass-treatment approach, the study says.
"You
only have to reduce risk by a small amount for [daily vitamin supplements]
to be cost-effective. If lowering homocysteine reduces cardiovascular
risk by 50 percent, it would be more cost-effective. But if it's
only 10 to 15 percent, it would still be cost-effective," says
study co-author Dr. Brahmajee Nallamothu, a cardiology fellow at
the University of Michigan. The findings suggest that people would
benefit from screening for homocysteine, even in the absence of
solid data on the effects of reducing the enzyme, the study says.
A
typical test for homocysteine costs from $20 to $70, Nallamothu
says. Results of the study appear in today's issue of the Archives
of Internal Medicine. Dr. Peter Block, an Emory University heart
specialist, says taking vitamin supplements and eating fortified
breakfast cereals are good ways to reduce the risk of cardiovascular
problems related to homocysteine, at least for most people. But
he cites research that suggests some people may respond to folate
with increased homocysteine, which could be deadly. "Some people
have a paradoxical response to folic acid intake," Block says.
So he says anyone who has high homocysteine and starts eating folate
to correct it should be tested again in a few months to make sure
the level of the enzyme isn't rising. "It's a very small percentage
[of people], but it's real," Block says of the danger.
What
To Do: If you haven't had your homocysteine screened, ask your doctor
about the test. If you take folic acid, you also should be sure
to take 500 milligrams of vitamin B12 a day because experts say
folate can mask deficiencies in the second nutrient. But lowering
homocysteine isn't considered the only, nor even the best way for
most people to reduce their risk of heart-related death. Most experts
believe that quitting smoking, lowering cholesterol and getting
regular exercise probably are far more important. To learn more
about homocysteine, check the American Heart Association or the
American College of Cardiology online. Or, you may want to read
previous HealthScout articles on folic acid and heart disease.
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Protecting
Your Heart on the Cheap By Adam Marcus HealthScout Reporter
March 3, 2003 3:40 PM
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