Cost-effectiveness of Vitamin Therapy to Lower Plasma Homocysteine Levels for the Prevention of Coronary Heart Disease

Tice JA, Ross E, Coxson PG, et al.

Homocysteine Levels and Heart Disease High levels of homocysteine in the plasma have been associated with coronary heart disease (CHD) and mortality from cardiac events. In an effort to lower these homocysteine levels, thereby reducing heart disease, the FDA requires that all grain products that claim to be "enriched" contain at least 140 µg of folic acid per 100 g. Study Design Researchers studied the effects of grain fortification with folic acid on the incidence of heart attack, death from coronary events, and the quality-adjusted life-years (QALYs) saved. The study was also designed to evaluate costs associated with vitamin supplementation of folic acid and cyanocobalamin. A comparison was made between subjects on a diet that included enriched grain products that increased folic acid intake by 100 µg per day and subjects without folic acid fortification. Incidence was also compared based on vitamin therapy supplementation versus fortification only from diet. Results The study found that grain fortification with folic acid should decrease CHD events and mortality by 8% in women and 13% in men. Furthermore, the combination of grain fortification plus supplemental vitamin therapy was predicted to decrease the number of deaths by 310,000 over ten years. Over this same time span, combined therapy was projected to significantly save QALYs and $2 billion in medical costs. Conclusion Vitamin supplementation including folic acid and cyanocobalamin may be a cost-effective way to prevent CHD. However, further research is necessary to confirm that lowering homocysteine levels also lowers the incidence of CHD events. Return to Top