Increased dietary micronutrients decrease serum homocysteine concentrations in patients at high risk of cardiovascular disease

Background: Elevated blood homocysteine is a risk factor for cardiovascular disease. A 5-mu mol/L increase is associated with an approximate to 70% in crease in relative risk of cardiovascular disease in adults. For patients w ith established risk factors, this risk is likely even greater. Objective: Effects of increased dietary folate and recommended intakes of v itamins B-12 and B-6 on serum total homocysteine (tHcy) were assessed in in dividuals at high risk of cardiovascular disease. Design: This trial was conducted at 10 medical research centers in the Unit ed States and Canada and included 491 adults with hypertension, dyslipidemi a, type 2 diabetes, or a combination thereof. Participants were randomly as signed to follow a prepared meal plan (PMP; n = 244) or a self-selected die t (SSD; n = 247) for 10 wk, which were marched for macronutrient content. T he PMP was fortified to provide greater than or equal to 100% of the recomm ended dietary allowances for 23 micronutrients, including folate. Results: Mean folate intakes at 10 wk were 601 +/- 143 mu g/d with the PMP and 270 +/- 107 mu g/d with the SSD. With the PMP, serum tHcy concentration s fell from 10.8 +/- 5.8 to 9.3 +/- 4.9 mu mol/L (P < 0.0001) between weeks 0 and 10 and the change was associated with increased intakes of folate, v itamin B-12, and vitamin B-6 and with increased serum and red blood cell fo late and serum vitamin B-12 concentrations. tHcy concentrations did not cha nge significantly with the SSD. Conclusions: The PMP resulted in increased intakes and serum concentrations of folate and vitamin B-12. These changes were associated with reduced ser um tHcy concentrations in persons at high risk of cardiovascular disease.