The Pharmaceutical Journal
Vol 269 No 7214 p312
7 September 2002

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JAMA (jama.ama-assn.org)
European Society of Cardiology (www.escardio.org)

Folic acid could prevent heart disease in smokers

Folic acid supplements enhance endothelial function and decrease blood pressure in young smokers, researchers have found.

Dr Arduino Mangoni and colleagues from Guy's, King's and St Thomas' School of Medicine, London, randomly assigned a group of 24 healthy cigarette smokers with a mean age of 38 years to receive either 5mg folic acid a day or placebo for four weeks.

They found that folic acid supplementation reduced plasma homocysteine levels by about a quarter, from 10.8±0.6 to 8.2±0.5mmol/L. It also increased arterial dilation by 65 per cent and decreased blood pressure, from a mean of 88±2mmHg to 83±1mmHg. No such changes were observed in the placebo group.

The exact mechanism by which smoking exerts deleterious effects is unknown, but the researchers postulated that homocysteine, which increases in chronic smokers and is known to make arteries stiffer by impairing endothelial function, could be the link between smoking and cardiovascular disease. Although folic acid supplementation decreased homocysteine levels, the researchers found that resulting arterial benefits were more closely related to increased blood levels of folic acid, rather than decreased homocysteine levels.

They conclude: "The results of our study suggest that a cheap, effective and non-toxic vitamin supplement provides significant benefits and mitigates the abnormalities observed in this high-risk group, thus providing cardiovascular protection."

However, Dr Mangoni told The Journal that pharmacists should wait for the results of several large major trials currently in progress, before making any recommendations to the public. In addition, he said it was important for people not to glean the wrong message from the findings: "The wrong message would be if we gave these people folic acid and allowed them to keep smoking."

Instead, he said sustained effort should be targeted at smoking cessation programmes because the rate of smoking cessation in the United Kingdom was still far too low. Folic acid supplementation should be viewed as a last line of defence for those smokers who have the greatest difficulty in stopping, he added. The study was presented as a poster at the European Society of Cardiology annual congress in Berlin, earlier this week.