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Chris,

I heard your talk and was surprised the issue of homocysteine was never discussed as a marker for heart disease. High homocysteine levels often are a result of inadequate levels of vitamin B12, B6 and folate (vitamin B9) or an under active thyroid. This is detailed in the book “The Heart Revolution: The Extraordinary Discovery That Finally Laid the Cholesterol Myth to Rest” by Kilmer McCully, M.D. Dr. McCully shows how homocysteine is a more accurate marker for heart disease than testing cholesterol and that a deficiency in certain B vitamins causes damage to arterial walls and cholesterol responds to this damage. Eating foods high in B vitamins along with supplementation reverses this damage and significantly reduces heart disease risk. On page 23 he summarizes major studies. This passage is copied below. You seem ignorant of this research and don’t offer a simple marker that has been shown to identify heart disease risk, except to be concerned about very high cholesterol levels. As Dr. McCully states: “Eating a cholesterol-rich diet doesn’t cause heart disease, and measuring blood levels of cholesterol fails to predict heart disease in most of those who have it.”

Begin book excerpt:

“• In February 1998 investigators at the Harvard School of Public Health published the results of the Nurses’ Health Study, one of the studies that originally set out to prove that cholesterol was causing heart disease. Instead this study has shown that deficiencies of B vitamins are doing the damage. During a fourteen-year period, 80,000 participants answered questionnaires about their food consumption. The study revealed that those nurses with the lowest consumption of folic acid and B6 had the highest death rates from cardiovascular disease and heart attack.
• In April 1998 investigators from England published a study of 21,500 men who were followed for almost nine years. Blood homocysteine levels were higher in men who died of heart disease than in men who did not. The higher the blood homocysteine level, the higher the risk of dying from heart disease.
• The Physicians Health Study, completed in 1992, showed that among the 14,000 participants, those with high homocysteine were three times more likely to have a heart attack during a five-year period than persons with normal levels.
• In the 1996 Nutrition Canada Study of 5,000 people studied for fourteen years, those with the lowest levels of folic acid in the blood were almost twice as likely to die from heart disease as those with the highest levels.
• A study from Norway showed that among 587 patients with proven coronary heart disease, risk of death is directly related to the level of homocysteine in the blood. Cholesterol level, on the other hand, did not predict the risk of death.

• The Hordaland Study of 16,000 residents of Bergen, Norway, showed that homocysteine increases in the presence of other known risk factors for heart disease, including male gender, old age, smoking, high blood pressure, elevated cholesterol level, and lack of exercise.
• A multicountry study in 1997 showed that the death rate from coronary heart disease is directly related to blood homocysteine levels. In northern European countries, where heart disease is frequent, people have higher blood levels of homocysteine than in southern European countries, where heart disease is less frequent.

The study in Hordaland, Norway, is especially interesting because a variety of factors associated with heart disease were related to high blood homocysteine. Known risk factors for heart disease–aging, male gender, menopause, lack of vegetables and fruits or vitamin supplements, lack of exercise, high blood pressure, and smoking–cause homocysteine levels to rise. The studies from Canada and the Nurses Health Study show directly that death from heart disease is related to dietary deficiencies of folic acid and vitamin B6. The Physicians Health Study and the British study show that elevated blood homocysteine increases the risk of dying from heart disease. All these studies are powerful evidence supporting the validity of the homocysteine theory of heart disease.

There are, in fact, many cases of heart disease in which cholesterol levels are quite normal. Usually these patients have high homocysteine that is independent of cholesterol; remember J.E. from the first case study. In 1990 a study at the Providence V.A. Medical Center showed that the patients with the most advanced arteriosclerosis typically had normal cholesterol levels, and two-thirds of all these patients had no hypertension, diabetes, or elevated cholesterol at all. Only about 15 percent of cases with severe arteriosclerosis had high cholesterol. Eating a cholesterol-rich diet doesn’t cause heart disease, and measuring blood levels of cholesterol fails to predict heart disease in most of those who have it.”

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