DALLAS, Texas--In the upcoming January 5-12, 1999, issue of Circulation: Journal of the American Heart Association, the AHA issued a Science Advisory urging doctors to begin screening high-risk patients with a personal or family history of heart disease for homocysteine levels in the blood and urged all Americans to increase intake of foods containing folic acid, vitamins B6 and B12, such as Total, made by General Mills, as well as leafy green vegetables, fruits, legumes, and other good sources.
"This is a major announcement by the American Heart Association," said James Rippe, M.D., of Tufts University Medical School. "As a cardiologist, I will be directing my patients to make an easy, manageable change in their daily routines, namely eat a fortified breakfast cereal such as Total, which was used in a landmark study cited in the AHA's Science Advisory."
Total breakfast cereal contains 100 percent of the Daily Value of folic acid, vitamins B6 and B12 and was used in research to lower blood levels of homocysteine. A 1/2 cup of Total cereal was eaten daily by patients in a 15-week randomized double-blind, placebo-controlled clinical trial and lowered blood levels of homocysteine by an average 11 percent, according to a study published in the New England Journal of Medicine. The study was among the research that led to the AHA announcement.
Despite more than 80 epidemiological studies demonstrating connections between plasma homocysteine levels and cardiovascular disease, more long term clinical studies are needed before prescribing a more aggressive approach for treating high homocysteine, according to the AHA Science Advisory.
"Until results of controlled clinical trials become available, emphasis should be placed on meeting current Daily Value for folic acid, B6, B12 by intake of ready-to-eat fortified cereals, leafy green vegetables, fruits, and legumes," said the AHA Science Advisory.
The only source of food that contains all three critical vitamins--folic acid, vitamins B6 and B12--listed in the AHA's Science advisory is "ready-to-eat fortified cereals."
"Since a significant proportion of the population does not meet the current Daily Value for folate intake, a reasonable population approach is to recommend an increase in the intake of foods containing those vitamins, i.e. ready-to-eat fortified cereals, leafy green vegetables, fruits and legumes," said the AHA Science Advisory.
Folic acid from cereal grain products is more readily absorbed than naturally occurring folate found in fruits and vegetables, which lose vitamin content after storage and cooking, the AHA said. "Prolonged heating or boiling followed by discarding of water or microwave heating may reduce folate content of food," said the Science Advisory.
Sources of folic acid include: Total cereal with 400 micrograms (100 percent of the Daily Value); lentils with 180 micrograms; kidney beans with 115; soybean nuts with 120; asparagus and spinach with 130; and broccoli with 40. High levels of blood homocysteine are present in an estimated 20 million Americans or more than one of every three people with cardiovascular disease. Homocysteine is an amino acid that circulates in the blood much like cholesterol. Folic acid, vitamins B6 and B12 help break down homocysteine. Homocysteine seems to damage artery walls and precipitate plaque build-up.
The American Heart Association has been reviewing mounting evidence of the connection between homocysteine and cardiovascular disease for almost two years and felt it needed to make a statement to doctors now since clinical studies will not be completed for another four to seven years, according to Rene Malinow, M.D., lead author of the Science Advisory.
Dr. Malinow of the Oregon Health Sciences University in Portland is a world-renowned scientist and leading researcher on the topic of homocysteine. He is joined in authorship of the AHA Science Advisory by Andrew Bostom, M.D., Memorial Hospital of Rhode Island and Ronald Krauss, M.D., Lawrence Berkley National Laboratory, Berkley, Calif.
When the AHA Nutrition Committee met in November 1998, they announced that homocysteine is "worthy of consideration by the press, the American public and the world." They added that homocysteine is a potential non-traditional risk factor and that "diet is a major controlling factor for blood levels of homocysteine."
According to the Science Advisory, "a number of studies have shown inverse relationships of blood homocysteine concentrations with plasma/serum levels of folic acid, vitamin B6 and vitamin B12."
Homocysteine is an emerging risk factor for cardiovascular disease, this country's leading cause of death. One million Americans are projected to die of cardiovascular disease in 1998. An American dies from cardiovascular disease every 33 seconds, and the toll on this country's economy exceeds $150 billion annually.
About 30 years ago, scientists noticed that children with a rare genetic disorder associated with elevated blood homocysteine developed premature cardiovascular disease, but only recently have scientists studied homocysteine as a risk factor for cardiovascular disease in adults as well as the effect of folic acid and other B vitamins in lowering homocysteine.
"It will probably soon be as common to have one's homocysteine level checked as it is now to have one's cholesterol level checked," said Dr. Malinow. "Folic acid, vitamins B6 and B12 are likely to become significant weapons in the war against heart disease."
Consumers who would like more information on the health benefits of folic acid and eating Total for breakfast can call toll-free: 1-800-427-4883.