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Folic Acid-Based Intervention in Non-ST Elevation Acute Coronary Syndromes
Asian Cardiovascular and Thoracic Annals, 06/15/09

Imasa MSB et al. - Folic acid-based supplementation is not beneficial and may even be harmful in the secondary prevention of cardiovascular events in patients with unstable angina and non-ST-elevation myocardial infarction. Further studies on the safety of such supplements are suggested.

Exclusive Author Commentary
Jose B Nevado, 06/13/09

Homocysteinemia is considered to be a novel risk factor and a good predictor for adverse cardiovascular outcomes, and approaches to lower blood levels of homocysteine may provide benefit. High-dose folic acid-based supplementation to lower homocysteine levels has been studied in several clinical trials, but such strategy did not show conclusive clinical benefit. Interestingly, the Folate Intervention in non-ST Elevation MI and Unstable Angina study (FINEST study) demonstrates a significant increase in the composite endpoints of death, serious rehospitalization and nonfatal acute coronary syndromes for the subjects. Though the mechanism of this harm is not elucidated, it is hypothesized that toxicological effects of prolonged intake of high doses of supplements may potentially confer such harm to the subjects. Hence, the study underscores the need for safety research for all substances, including recognized food supplements, before any attempt for interventional applications. Lastly, though our study did not support a beneficial effect homocysteine level modification, we are not indicating that homocysteine lowering is not potentially useful. We suggest that alternatives to folic acid-based approaches be investigated to determine the potential benefit of lowering blood homocysteine.

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