Re: stroke, homocysteine and B 12

From: David Rind (drind_at_caregroup.harvard.edu)
Date: 03/02/05 

Date: Tue, 01 Mar 2005 22:14:55 -0500

Zee wrote:
> I was hoping you would comment. I am being told I *must* lower my
> homocysteine. It has not responded to folate. I am also told my
> physcians are "very worried" about my ldl cholesterol. These comments
> are usually followed by my getting a "non-compliant patient" talk
> followed by a sign-off as patient letter cc'd to my general
> practitioner.
>
> Did you see the recent post about pantethine to lower cholesterol? Do
> you have any thoughts on that? I would welcome your opinion.
>
> Zee

I'm not sure my comments will be too helpful for a couple of reasons:

First, it's hard for me to make useful comments about for an individual
over the Net -- it's just not similar to the information available when
seeing a patient.

Second, my approach to high risk cardiac situations is the one you like
least. If I were really worried that someone's homocysteine level (plus
some number of other risk factors) placed them at too high a risk for
cardiovascular disease, my approach would be to have them take a statin.

High homocysteine levels do seem to correlate some with cardiovascular
risk, but we really don't know that lowering those levels with folate
(or with folate plus other vitamins) really has any important impact on
that risk. I don't know of any evidence that anyone "must" lower their
homocysteine level, since we don't actually know that doing so has any
beneficial effect. In contrast, statins clearly lower cardiovascular risk.

I didn't notice the post on pantethine (is this pantothenic acid?), but
in the absence of any specific information my take would be similar to
what I posted a while ago about ezetimibe (and also similar to what I
wrote about lowering homocysteine levels above). Knowing that something
lowers cholesterol levels in and of itself isn't that convincing to me
that it will show clinical benefit. It is really not at all clear that
the benefit of statins doesn't have a lot to do with effects separate
from lowering cholesterol levels. I believe we really need trials with
clinical endpoints for any drug intended to treat hypercholesterolemia. 

-- 
David Rind
drind@caregroup.harvard.edu

Relevant Pages

  • Re: stroke, homocysteine and B 12
    ... It has not responded to folate. ... my approach to high risk cardiac situations is the one you like ... If I were really worried that someone's homocysteine level (plus ...
    (sci.med)
  • Re: Strategies for People to Raise Their Levels of Good HDL Cholesterol
    ... origins or homocysteine elevations as those simply due to vitamin ... >> their homocysteine with vitamin B supplementation. ... >Yes but maybe not the risk if comorbity of factors coexist in both risk and ... >Reduction of the homocysteine level does not reduce the risk. ...
    (sci.med.cardiology)
  • Re: Strategies for People to Raise Their Levels of Good HDL Cholesterol
    ... origins or homocysteine elevations as those simply due to vitamin ... Yes but maybe not the risk if comorbity of factors coexist in both risk and ... Studies do show an association of increased risk of those with an elevated ... Reduction of the homocysteine level does not reduce the risk. ...
    (sci.med.cardiology)
  • Re: Folate and restenosis
    ... >>Do you know what your homocysteine level was before you began folate ... >Those with very high homocysteine may benefit from the homocysteine lowering. ... >effect from the vitamins that overshadows the homocysteine-lowering benefit ... mi) or so I guess I'll continue to take folate. ...
    (sci.med.cardiology)
  • Re: the business of carbs or is it the conspiracy or carbs?
    ... But studies on the whole seem to show that reducing homocysteine worsens ... rather than improves risk of heart disease and stroke. ... about 10% less coronary heart disease and about 20% less stroke. ... The 10-year CHD risk ...
    (sci.med.nutrition)
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