The role of folic acid in the prevention of cardiovascular disease

Coronary heart disease is the leading cause of death in the developed world . Current surgical and pharmacological interventions are essentially pallia tive and interest in preventive strategies, particularly through nutrition and avoidance of tobacco has increased in recent years. Basic scientific, clinical and epidemiological evidence indicates a positiv e association between the plasma level of the amino acid homocysteine and v ascular disease. Homocysteine levels are inversely related to both intake a nd plasma levels of folate, Less strong evidence indicates an inverse relat ionship between folate intake and coronary heart disease risk. It is likely that current estimates of dietary folate requirements are lower than optim al. Folic acid supplementation reliably reduces homocysteine levels, and ma y also modify endothelial function independent of this effect on homocystei ne. Such treatment is cheap and appears to be essentially free of risk. How ever, until present randomised control trials are complete, it will not be known definitively whether or not increasing folate intake reduces cardiova scular risk. Curr Opin Lipidol 11:577-587. D 2000 Lippincott Williams & Wil kins.