B-Vitamins may not Protect Against Heart Disease

A recent review of scientific data suggests that vitamin B6, vitamin B9 and vitamin B12 may not help prevent heart attacks, strokes or death in people with heart disease or risk factors for heart disease.

Vitamin B deficiencies have been associated with hyperhomocysteinemia, a condition characterized by high levels of an amino acid (called homocysteine) that has been linked to heart disease. Hyperhomocysteinemia does not cause symptoms, but it may irritate blood vessels, leading to blockages in arteries. Therefore, researchers set out to analyze the effects of B vitamins on heart attack and stroke incidence.

Researchers analyzed data from eight human trials that tested the effects of vitamin B6, B9, B12 or a combination of these supplements in 24,210 adults. The participants had 1) heart and blood vessel disease, 2) atherosclerosis or a history of stroke, heart attack or other complications 3) or major risk factors for heart disease. 

The authors concluded that vitamin-B supplements in addition to standard care did not reduce a person’s risk of heart attack, stroke or death for up to seven years of follow up.

Some herbs have also been suggested as possible therapies to reduce the risk of cardiovascular events. For instance, strong evidence suggests that the use of red yeast rice and soy may help lower cholesterol, thereby reducing the risk of heart disease.  Patients may also lower their risk of developing heart disease by eating healthfully, exercising regularly, maintaining a healthy weight and not smoking.

For more information about integrative therapies for heart disease, please visit Natural Standard’s Comparative Effectiveness database.

Comments

[Jerry]

Considering the participants of the study had 1) heart and blood vessel disease, 2) atherosclerosis or a history of stroke, heart attack or other complications 3) or major risk factors for heart disease, it does not come as a surprise that vitamin-B supplements did not reduce a person’s risk of heart attack, stroke or death. These people aren’t in the best shape to begin with. I find it hard to believe that adding a supplement would significantly alter their risks. It usually takes a major lifestyle modification in order to lower your risk for any of the above mentioned disease states.

[T.b.]

This is very interesting. Prior findings attest that folate (B9), pyridoxine phosphate (B6) and cobalamine (B12) are important micronutrients that aid enzymatic reactions in the regulation of homocysteine levels. An underlying concern with this research to note is the form of folate that was administered. As supplements were given, and as supplements are the oxidized metabolites of natural folates 5-MTHF and 5-formylTHF, unmetabolized folate (B9) is bound to collect in the circulatory system leaving it unavailable to enter the folate machinery and kick off the methylation cycle, which leads to a break down of homocysteine.

[Anne]

Many patients take red yeast rice to lower cholesterol because it is marketed as an herb, and that makes it appealing to those with negative perceptions of prescription drugs. However, the active ingredient responsible for decreasing cholesterol is lovastatin, which is a prescription drug in same class as Lipitor and Crestor. Therefore, red yeast rice is not as benign as patients might think because it has the potential to elevate liver enzymes and cause muscle aches. If patients self-treat and neglect to get their blood monitored periodically, then they also cannot be sure that the product is working effectively.

[Sweetbanana]

This finding is similar to a review made by the Journal of American Medical Association, which stated that there is no association between dietary fish intake and cardiovascular mortality. Result showed that consumption of fish at least once per week may reduce the risk of sudden cardiac death in men, but also claimed that men who consumed any amount of fish more than once per month had a risk of myocardial infarction (heart attack) equivalent to those that did not consume any amount of fish.

I believe to really understand these researches a thorough knowledge on heart disease is needed e.g. myocardial infarction, cardiac arrest, arrhythmia, stroke, cornoary disease e.t.c. All of these are different but all are related too.

Albert CM, Hennekens CH, O’Donnell CJ, et al. Fish consumption and risk of sudden cardiac death. JAMA. 1998; 279(1):23-28.

[mina]

I think it is fascinating that research can be conducted on various factors such as homocysteine to determine its effects on cardiovascular risk. However, at the same time, I do not think there is any replacement for a healthy lifestyle. In a way, the fact that this study suggests that HLIs are not beneficial in decreasing the risk of cardiovascular risks is a "blessing." The reason I say this is that many times, people find an excuse to blame their unhealthy living on factors such as hyperhomocysteinemia. The fundamental fact is that the population needs to take a more active role in eating healthily, exercising and smoking cessation to really see a difference in the incidence of cardiovascular events.

[Andrew]

It is probably true that supplementation with B-vitamins does not significantly protect against heart disease, but patients should not get the idea that B-vitamins are not important to include in their diet. A diet naturally rich in B-vitamins is likely to contain substantial amounts of other important nutrients and lower amounts of compounds that contribute to heart disease. One has to keep in mind the big picture of healthy eating and disease prevention and not simply focus on tiny details. For example, a person cannot eat fast food three times a day, take a vitamin at night, and then expect to remain in perfect health.

[Eli]

It may seem strange, but I am glad this study turned out the way it did. I think it is good to send the message that pills and supplements, such as B-vitamins, are not the answer to heart disease. I hope the last line, about making healthy lifestyle choices, is the take-home point here.

[D.F.]

The conclusions made from this review are definitely interesting. However, I think that the researchers forgot to point out, or selectively left out the effect of vitamin B supplementation on death due to cardiovascular events. Though it may not prevent these events from happening, omitting this result leaves the possibility that there was a reduction in death due to cardiovascular events. If this is the case then vitamin B is still essential in protecting patients at risk for such events. If there is a benefit in patients that have stroke and MI in terms of survival, this cannot be overlooked. Perhaps there is a protective benefit for survival as opposed to preventing the actual event.

[Tasha]

Jerry makes an excellent point about the subjects perhaps being beyond the scope of help from supplements. I read an interesting study the other day. It used data from the British Whitehall study. One of the key points was that men who were smokers, had high blood pressure and had high cholesterol in their 40s and 50s were able to extend their lives by fairly predictable numbers of years by improving these three risks by the time the next data were gathered, 28 years later. So, more evidence for you that lifestyle counts, although I would imagine many of these men also used medications to lower their cholesterol and improve their blood pressure?

[CeCe]

I am curious to know the doses of vitamin B6, B9 and B12 that were given to the subjects in these trials. The recommended dietary allowances (RDA) for B6 for men and women who are 51 years and older are 1.5mg and 1.7mg, respectively. In adults, the RDA of vitamin B9 is 400mcg, while the RDA for vitamin B12 is 2.4mcg. It would be interesting to know if the RDA doses were used or if other doses were used for testing. It would also be interesting to know the effects of the different doses of each vitamin-B complex.

[EH]

I agree with DF that it would perhaps be meaningful to look at the effects of B vitamins on the mortality rate among these participants suffering from cardiovascular diseases. There was one study done in Israel last month that showed that patients with early-onset CAD and hyperhomocysteinemia had significantly lower mortality rates than those who did not take B vitamins. The researchers also found no effect of B-vitamin supplementation on mortality in those with normal plasma homocysteine levels.

Besides, seven years of follow-up was relatively short compared to previous studies that followed patients for around 10 years with positive results. I also wonder about the dosages of B vitamins that were prescribed because in the Israel study, their participants were given 5mg folic acid tablets three to seven times a week. They also took vitamin B12 sublingually at 1mg/week or orally at 0.25-0.4 mg per day. The folic acid dosage in particular was quite high.

*Dr Aviv Mager (Rabin Medical Center, Petah Tivka, Israel) and colleagues report their findings in the September 15, 2009 issue of the American Journal of Cardiology.

[Emma]

Then it means we were wrong that vitamin B is helpful for heart disease.

[Tina]

I think the point that Anne brought up about red yeast rice is important. Many patients are looking for the natural way to treat their cholesterol, but what they don’t realize is that red yeast rice is lovastatin, a common prescription cholesterol treatment. Patients should be aware that even if something is a natural product, it still can have adverse effects and interactions with their other medications. It is important for them to discuss herbal product usage with their doctors before self-treating.

[Tony]

Tina brought up a very important point. Patients (in general) think because something is natural, it doesn’t have any side effects or that it may not be harmful. As I heard from someone before, everything has the potential to be good, but is the amount ingested that makes it a poison.

[Carl]

What causes hyperhomocysteinemia? Is it heart disease, the causes of heart disease or something entirely different? This compound has been generating quite a bit of buzz in relation to cardiovascular health, but there is still so much unknown about the specifics. Perhaps there are other drugs or supplements out there that will have a greater lowering effect than the B vitamins. People should still strive to get adequate amounts of B vitamins in their diets for good health, regardless of the homocysteine implications.

[hearty]

According to the American Heart Association, “hyperhomocysteinemia is not a major risk factor for cardiovascular disease. We don't recommend widespread use of folic acid and B vitamin supplements to reduce the risk of heart disease and stroke. We advise a healthy, balanced diet that's rich in fruits and vegetables, whole grains, and fat-free or low-fat dairy products.” Of course, it’s already known, I think the most important point here is to encourage America to eat healthy diets along with active lifestyles to reduce the risk of cardiovascular disease.

[TK]

Like several people have stated already, lifestyle modifications should be addressed when trying to protect against heart disease. I think our society relies too heavily on quick fixes and not on doing things the right way (usually a long and tedious process). Rather than try to change your diet or exercise more, people want a way to avoid doing that by simply taking a pill. While advances are being made with medicine, nothing can beat the natural way of doing things. While taking a pill may solve some problems, it will almost always lead to some other problem. People need to rely less on medications and more on self control, perseverance and hard work.

[TMM]

My first question is: would the outcome of these studies be different if foods rich in B6, B9 and B12 were used instead of supplements? We all know the quality of over-the-counter vitamins can be questionable. Receiving vitamins from natural sources is far more beneficial than from a pill bottle. It’s also unclear as to what type of diet the subjects were on while taking the vitamins. Did they have a choice, or was there a diet? I feel the subjects would have made better choices in their diets if there vitamin intake was solely from food sources. This would also lead to an over all improved heart health.

[Lia]

I agree that it is important to make patients aware of risk when it comes to supplements. Conversely, I think it is important to consider the placebo effect. When it comes to something like B-vitamins, I am very hesitant to tell a patient to stop taking them if it makes them feel better and have a sense of control over their health.

[Willy]

When looking at what prevents heart disease, or any disease for that matter, one must look at the whole picture. It’s about being all around healthy, which includes things like diet and exercise. If someone is not eating healthfully or exercising, they cannot expect that just because they get their daily recommendation of B-vitamins, that it’s going to lower their chances of heart disease. Also, the source of these B-vitamins is very important, getting them from a natural source is much better than synthetically made vitamins.

[SM]

Although hyperhomocysteinemia is thought to possibly promote arthersclerosis, the American Heart Association (AHA) doesn’t consider hyperhomocysteinemia a major risk factor for cardiovascular disease. Therefore, even though B vitamins are thought to help break down homocysteine in the body, it may have little clinical effect in protecting against heart disease, especially in such high-risk patients such as the participants examined in these trials.

In addition, it states on the AHA Web site that they don't recommend B vitamin supplements to reduce the risk of heart disease and stroke, but rather a healthy diet and exercise.

[Sam]

Although this study shows that vitamin B does not prevent against heart disease in people with preexisting characteristics that would put them at risk of a stroke or heart attack, it does not necessarily rule out the potential impact that vitamin B might have on patients without this past medical history. I wonder if there has been research into the use of vitamin B in the prevention of heart disease in healthy patients with no history of heart disease, heart attack or stroke.

[Etta]

In response to Sam:

The objective of the study, as stated in the abstract is "To assess the clinical effectiveness of homocysteine-lowering interventions (HLI) in people with or without pre-existing cardiovascular disease." Since B vitamins are included in HLI, your question has been covered by this study. Furthermore, it is about a recent meta-analysis, so the authors have already looked for any studies on the topic.

[Reg]

This study focused on vitamins B6, B9 and B12, so I looked those up in the Natural Standard database. The information there supports the recent review that these vitamins may lower homocysteine levels, but that does not necessarily lower the risk of heart attack or stroke, despite the link between hyperhomocysteinia and heart disease. From my layman’s point of view, it seems that if one has such serious condition as atherosclerosis, history of stroke or heart attack, or major risk factors for heart disease, as did the patients in the studies, then taking vitamins is simply not going to cut it. More drastic measures have to be taken.

[slimming tablets]

It is probably true that supplementation with B-vitamins does not significantly protect against heart disease, but patients should not get the idea that B-vitamins are not important to include in their diets.