In a large clinical trial involving patients with coronary artery disease, use of B vitamins was not effective for preventing death or cardiovascular events, according to a study published in the August 20, 2008 issue of JAMA.

“Observational studies have demonstrated that the concentration of total homocysteine in blood is associated with risk of coronary artery disease and stroke,” the authors provide as background information. Plasma total homocysteine levels can be lowered by oral administration of folic acid and vitamin B12. In this study, the authors’ objective was “to evaluate the effects of homocysteine-lowering treatment with folic acid plus vitamin B12 on mortality and cardiovascular events.”

Marta Ebbing, M.D. of Haukeland University Hospital, Bergen, Norway and colleagues, conducted a randomized controlled study with 3,096 patients in two Norwegian hospitals between 1999 – 2006. Patients were randomly assigned to one of four groups receiving a daily oral dose of one of the following treatments: folic acid, 0.8mg, plus vitamin B12 , 0.4mg, plus vitamin B6 , 40mg (n= 772); folic acid plus vitamin B12 (n = 772); vitamin B6 alone (n = 772); or placebo (n = 780). Patients were scheduled for follow-up visits with an interview, clinical examination, and blood sampling at one month, one year, and at a final study visit. The main outcome measure (primary end point) was a composite of all-cause death, nonfatal acute myocardial infarction (heart attack), acute hospitalization for unstable angina pectoris, and nonfatal thromboembolic stroke.

The study was stopped early because of concerns among the participants about preliminary results from another similar Norwegian study suggesting no benefits from the treatment and an increased risk of cancer from the B vitamins.

“Mean (average) plasma total homocysteine concentration was reduced by 30 percent after 1 year of treatment in the groups receiving folic acid and vitamin B12,” the authors report. “During a median (midpoint) 38 months of follow-up, the primary end point was experienced by a total of 422 participants (13.7 percent): 219 participants (14.2 percent) receiving folic acid/vitamin B12 vs. 203 (13.1 percent) not receiving such treatment and 200 participants (13.0 percent) receiving vitamin B6 vs. 222 (14.3 percent) not receiving vitamin B6.”

“… we could not detect any preventive effect of intervention with folic acid plus vitamin B12 or with vitamin B6 on mortality or major cardiovascular events among patients with stable coronary artery disease undergoing intensive conventional treatment. We found a numerically lower incidence of stroke and higher incidence of cancer in the groups receiving folic acid, but these observations were not statistically significant,” the authors conclude. “Our findings do not support the use of B vitamins as secondary prevention in patients with coronary artery disease.”
(JAMA. 2008; 300[7]: 795-804)

About Coronary Artery Disease (CAD)

Coronary artery disease (CAD), also called coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart.

CAD is the leading cause of death in the United States for men and women. According to the American Heart Association, more than 15 million people have some form of the condition.

Coronary artery disease is caused by any problem with the coronary arteries that keeps the heart from getting enough oxygen- and nutrient-rich blood. The most common cause  is atherosclerosis which occurs when fatty material and a substance called plaque builds up on the walls of your arteries. This causes them to get narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop, causing chest pain (stable angina), shortness of breath, heart attack, and other symptoms.  Lack of sufficient blood is called ischemia, so coronary artery disease is sometimes called ischemic heart disease.

Risks for developing CAD include:

• Gender: Men in their 40s have a higher risk of CAD than women. But, as women get older, their risk increases so that it is almost equal to a man's risk. The cause of coronary artery disease is related to multiple risk factors. The following are the most common:
• Heredity: Coronary heart disease runs in the family. You're more likely to develop the condition if someone in your family has had it -- especially if they had it before age 50. Your risk for CAD goes up the older you get.
• High blood pressure
• High LDL "bad" cholesterol
• Low HDL "good" cholesterol
• High blood cholesterol: Levels of high blood pressure, high blood cholesterol in the blood are above healthy levels. This usually involves high levels of low-density lipoprotein (LDL), the bad cholesterol, and low levels of high-density lipoprotein (HDL), the good cholesterol.
• Not getting enough physical activity or exercise
• Obesity
• High-fat diet
• Stress
• Type A personality (impatient, aggressive, competitive)
• Tobacco abuse: This includes not only smoking any form of tobacco (cigarettes, cigars, pipes), but also chewing tobacco.
• Type 1 Diabetes
• Type 2 Diabetes
• Higher-than-normal levels of inflammation-related substances such as C-reactive protein and fibrinogen.
• Increased levels of a chemical called homocysteine, an amino acid, are also linked to an increased risk of a heart attack.
• Menopause

Coronary Artery Disease Symptoms

Symptoms may be very noticeable, but sometimes you can have the disease and not have any symptoms. Symptoms may include:

• Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. The severity of the pain varies from person to person.There are two main types of chest pain:
• Typical chest pain -- feels heavy or like someone is squeezing you. You feel it under your breast bone (sternum). The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin. Adults with typical chest pain have a higher risk of CAD than those with atypical chest pain.
• Atypical chest pain -- often sharp and comes and goes. You can feel it in your left chest, abdomen, back, or arm. It is unrelated to exercise and not relieved by rest or a medicine called nitroglycerin. Atypical chest pain is more common in women.

Other symptoms may include:

• Shortness of breath If your heart can't pump enough blood to meet your body's needs, you may develop symptoms of heart failure - shortness of breath, extreme fatigue with exertion, and swelling in your feet and ankles.
• Extreme fatigue with exertion (because of insufficient blood flow)
• Swelling in your feet and ankles.
• Heart attack  -- in some cases, the first sign of CAD is a heart attack. If a coronary artery becomes completely blocked, you may have a heart attack. The classic symptoms of a heart attack include crushing pain in your chest, pain in your shoulder or arm, and shortness of breath.  Sometimes a heart attack occurs without any apparent signs or symptoms. Note: women are somewhat more likely than men to experience other warning signs of a heart attack, including nausea and back or jaw pain.