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    You've heard of cholesterol. But there's another potential risk factor for heart disease you should know about.  Elevated levels of homocysteine, an amino acid in the blood, are associated with an increased risk of heart attacks and strokes. Homocysteine levels may prove to be as important as cholesterol in predicting heart health.  Several large-scale studies in the 1990's have implicated homocysteine as a possible factor in heart problems.

What's Normal?
   Normal homocysteine levels range between one and 10 micromoles per liter. Unlike cholesterol, which is considered problematic when it rises above 200 milligrams per deciliter, researchers haven't set a "safe" level of homocysteine. Researchers estimated that an increase of five micromoles of homocysteine per liter is equivalent to a 20-milligrams per deciliter increase in cholesterol.   The American Heart Association concluded that widespread screening for elevated homocysteine levels isn't needed until we learn more. However, the group suggested that people already at a higher risk of heart disease might consider getting tested. These include people with family history of heart disease, smokers, the obese and those with problems absorbing nutrients.  In a study of 15,000 physicians, 5 percent of the group with the highest homocysteine levels had at least three times the risk of heart attack than people with lower levels. Later, it was estimated that 10 percent of the risk of cardiovascular disease could be attributed to elevated homocysteine levels, which appear to damage artery walls.

How does Homocysteine Affect Cardiovascular Health?
    One theory is that homocysteine interferes with the ability of the lining of blood vessels, called the endothelium, to secrete nitric oxide, which helps regulate blood pressure by relaxing and expanding blood vessels when blood flow increases. Another theory is that homocysteine is involved in arteriosclerosis, the dangerous buildup of fatty substances in arteries.

Diet Can Help
   The good news is that homocysteine levels can often be managed with diet. Three nutrients in particular can help lower elevated homocysteine levels: folic acid, which is abundant in green leafy vegetables, oranges and fortified cereals; vitamin B-6, found in meats and fortified cereals; and vitamin B-12, found in meats, potatoes, bananas and fortified cereals. These nutrients are believed to help keep homocysteine in check by helping it convert into other substances in the blood that aren't associated with heart disease.  Some studies show that many people in general, not only those with elevated homocysteine levels, are deficient in these nutrients. Eight eight percent of Americans get less than the recommended amount of folic acid, which can also help reduce risk of some birth defects.

Key Issues Yet To Be Resolved
    It seems clear that extremely high homocysteine levels are associated with an increased risk of heart disease and stroke,  the top and third leading causes of death in the United States. The key question is will the reduction of homocysteine levels in the blood mean less chance of a heart attack and stroke? From a biologic standpoint this makes sense, but it may take a few more years to prove it.

How I Would Use This Motor Control Information When Working With A Person In My Career
     Nutritionists should recommend that clients follow the expert advice of consuming 400 micrograms of folic acid each day, the amount found in a cup of many fortified cereals. Individuals can also get that amount by consuming six asparagus spears, a cup of orange juice, a half cup of lentils and two slices of whole wheat bread.  The recommended daily consumption for vitamins B-12 (2.4 micrograms), the amount found in a chicken breast, a hard boiled egg and a cup of yogurt, and  B-6 (1.3 to 1.7 milligrams), which can be found a baked potato (with its skin) and a banana, should also be followed.  Further, many experts suggest a multiple vitamin or a B-complex vitamin when there is any doubt about adequate dietary intake of folic acid, B-6 or B-12.


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