Q. I am due to have angioplasty in two weeks. I know this procedure is necessary now, but I want to prevent further deterioration of my heart condition. What is helpful?
A. Angioplasty, the mechanical opening of arteries that supply blood to the heart, is a lifesaver in many ways. The major drawback is that the arteries, once opened, often rapidly narrow down again. Blocking or “hardening” of the arteries is usually due to buildup of plaque, which narrows the corridor through which blood must pass and makes it easier for a blood clot to completely stop blood flow.
Although elevated cholesterol and triglyceride levels have long been associated with plaque buildup, other factors are also at work. These so-called “independent risk factors” for coronary artery disease include elevated blood levels of homocysteine, a toxic amino acid that increases when certain B-vitamins (folic acid, vitamin B-12, and vitamin B-6) are deficient. Research reported in the December 2001 New England Journal of Medicine has shown that these same B-vitamins also improve the success rate of angioplasty. Less than half the patients required follow-up surgery after angioplasty when they took 1,000 micrograms (mcg) of folic acid, 400 mcg of vitamin B-12 and 10 milligrams (mg) of vitamin B-6 per day for six months.
The nutrient amounts used in this research are quite large, representing about two and a half times the Dietary Reference Intake (DRI, the replacement number for Recommended Dietary Allowance or RDA for evaluation of nutrient intake) of folic acid, 80 times DRI of vitamin B-12 and five times the DRI for vitamin B-6. It is doubtful that the American diet could supply these amounts without serious overconsumption of calories, so use of food supplements in this situation seems inevitable.
Few nutritionists would consider supplementation of these nutrients at these levels to be dangerous. Still, the Food and Drug Administration would require a prescription for a product with this formula because folic acid is limited to 400 mcg per daily dose. To make matters worse, evidence suggests that folic acid is the most likely B-vitamin to be deficient in the American diet, partly because it is quite fragile. Simply cooking a food that is a good source of folic acid can destroy 80% of it, and we Americans are rather poor at eating raw food. Since we eat most fruit raw, it supplies most of our folic acid, but we would do well to eat English peas, asparagus, corn, and lots of other vegetables raw. Folic acid intake in America is still often less than the current DRI.
While staying aware of homocysteine elevation, another “independent risk factor” also deserves consideration. High levels of the blood-clotting agent fibrinogen, one of the proteins that accelerates blood clotting, predisposes a person to coronary and cerebral artery disease even when other known risk factors such as cholesterol and triglyceride are normal. Heart attacks were twice as common among men with high fibrinogen, and reducing the fibrinogen level reduced the risk of heart attack. Also, blood fibrinogen level is elevated in cigarette smokers, which of course increases the risk of cardiovascular disease.
The current popularity of aspirin relates in part to its ability to “thin the blood” and reduce the tendency of blood to clot. For those who have a problem taking aspirin daily, several nutrients will help. These include vitamin E, vitamin C, vitamin A, garlic, and the omega-3 family of fats, most abundantly found in fish oil. Several herbs such as gingko biloba and green tea may also be helpful. We can be thankful that that same time period that has witnessed the rise of heart disease, stroke, and diabetes has also seen the arrival of food supplements that can be used to prevent these “diseases of civilization.”
This article appears in 2001.