From the Guidelines
A homocysteine level of 18.6 μmol/L is elevated and should be treated with vitamin supplementation, specifically folic acid and vitamin B12, to reduce the level to less than 10 micromoles per liter, as recommended by the guidelines 1. The recommended treatment includes daily supplementation with vitamin B12 (500-1000 mcg) and folic acid (1-5 mg), as these have been shown to decrease homocysteine concentrations by 25% and 7%, respectively 1.
- The use of vitamin B6 is not recommended as it has no significant additional benefit in reducing homocysteine levels 1.
- Treatment should continue indefinitely with follow-up testing in 6-8 weeks to assess effectiveness.
- Dietary modifications are also important, including increased consumption of leafy greens, legumes, and fortified grains.
- Elevated homocysteine is associated with increased cardiovascular risk and may indicate underlying vitamin deficiencies or genetic disorders affecting methionine metabolism.
- Although the effectiveness of vitamin supplementation in preventing ischemic stroke is not well established, it may be considered for prevention in patients with hyperhomocysteinemia, as recommended by the guidelines 1.
- Patients should also address modifiable risk factors such as smoking cessation and maintaining healthy weight, as these can contribute to elevated homocysteine levels.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Homocysteine Levels and Treatment
- Homocysteine levels of 18.6 micromol/L or higher are associated with an increased risk of myocardial infarction and stroke in the elderly, as shown in the Rotterdam Study 2.
- Treatment with vitamins B6, B12, and/or folic acid has been shown to reduce homocysteine levels in patients with mild cognitive impairment, with a mean decline of 31.9% in homocysteine concentration 3.
- Folic acid, vitamin B12, and vitamin B6 are effective in lowering plasma homocysteine levels, with folic acid being the most effective, followed by vitamin B12 and then vitamin B6 4.
Reduction of Homocysteine Levels
- Supplementation with folic acid and vitamins B6 and B12 has been shown to reduce homocysteine levels, but did not significantly decrease the risk of major cardiovascular events in patients with vascular disease 5.
- The levels of folic acid, vitamins D2, D3, and B12 correlate with homocysteine levels in Chinese patients with type-2 diabetes mellitus, hypertension, or cardiovascular disease, with higher levels of folic acid and vitamins D2 and D3 associated with lower levels of homocysteine 6.
- Elevated homocysteine levels are associated with an increased risk of cardiovascular disease, and reducing homocysteine levels through supplementation with vitamins B6, B12, and/or folic acid may be beneficial in preventing cardiovascular disease 3, 4, 2.