Carotid intima-media thickness (CIMT) is a good marker for both the presence of early atherosclerosis and the degree of atherosclerosis within an individual. This new meta-analysis provides further evidence that folic acid therapy is suitable for populations with a high cardiovascular disease risk.
This is because folic acid is required to reduce the levels of homocysteine (a toxic amino acid that's been linked to an assortment of diseases) in the body.
However, the data surrounding the benefits of reducing high homocysteine is controversial. While it's been proven that high homocysteine increases the risk of cardiovascular disease (and a host of other diseases), lowering high levels of homocysteine has not reduced the risk in many studies. This strongly suggests that keeping homocysteine levels in check in the first place is essential--trying to reduce it after its high doesn't seem to offer much benefit.
Now, data from the new study adds to the potential heart cardiovascular benefits of folic acid, and found that supplementation was associated with less hardening of the arterial walls, particularly in people with a high risk of high cardiovascular disease or with chronic kidney disease.
The analysis included data from 10 clinical trials (a total of 2,052 people) and also found that the benefits were even greater when the researchers used data from trials that reported the greatest reductions in homocysteine levels.
Personally, I like to recommend the active metabolite of folic acid, 5-methyl-tetrahydrofolate (5-MTHF). Folic acid must be converted to 5-MTHF to be used by the body, and this is a multi-step process that occurs in the intestines and liver. However, in the presence of intestinal or liver dysfunction this conversion may not occur sufficiently enough to meet the body's needs. Furthermore, up to 60% of the U.S. population may have a genetic enzyme defect that makes it difficult for them to convert folic acid into 5-MTHF. For these individuals, 5-MTHF supplementation may be a much more effective. It may even be good for those without this genetic deficiency since newer research is suggesting unconverted folic acid in the body is not a good thing.
Source: Effect of folic acid supplementation on the progression of carotid intima-media thickness: A meta-analysis of randomized controlled trials
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