Department of Pharmacology, Toxicology, and Neuroscience, LSU Health Shreveport, Shreveport, LA, USA.
Department of Anesthesiology, LSU School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA.
Adv Ther. 2020 Oct;37(10):4149-4164. doi: 10.1007/s12325-020-01474-z. Epub 2020 Aug 26.
Folic acid is the most important dietary determinant of homocysteine (Hcy). Hcy serves as a critical intermediate in methylation reactions. It is created from methionine and either converted back to methionine or transformed into cysteine. This process is aided through several enzymes and three vitamins, folic acid, B12, and B6. Daily supplementation with 0.5-5.0 mg of folic acid typically lowers plasma Hcy levels by approximately 25%. Hyperhomocysteinemia is a known risk factor for coronary artery disease. In this regard, elevated levels of Hcy have been found in a majority of patients with vascular disease.
A literature review of folic acid supplementation for various disease states including cardiovascular disease was conducted. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.
In this review, we discuss the biochemistry of folic acid, Hcy biosynthesis, Hcy and hydrogen sulfide bioavailability, pathogenesis of hyperhomocysteinemia and its role as a risk factor for disease, and treatment studies with folic acid supplementation in disease states.
Folic acid supplementation should be recommended to any patient who has an elevated Hcy level, and this level should be measured and treated at an early age, since folic acid is easily obtained and may likely reduce vascular disease and other deleterious pathologic processes in high-risk populations.
叶酸是同型半胱氨酸（Hcy）最重要的膳食决定因素。Hcy 是甲基化反应的关键中间产物。它由蛋氨酸产生，要么转化回蛋氨酸，要么转化为半胱氨酸。这一过程通过几种酶和三种维生素（叶酸、B12 和 B6）来辅助。每天补充 0.5-5.0mg 的叶酸通常可使血浆 Hcy 水平降低约 25%。高同型半胱氨酸血症是冠心病的已知危险因素。在这方面，大多数血管疾病患者的 Hcy 水平升高。
对包括心血管疾病在内的各种疾病状态下叶酸补充的文献进行了综述。本文基于以前进行的研究，不包含任何作者进行的涉及人类参与者或动物的研究。
在这篇综述中，我们讨论了叶酸的生物化学、Hcy 生物合成、Hcy 和硫化氢的生物利用度、高同型半胱氨酸血症的发病机制及其作为疾病风险因素的作用，以及叶酸补充在疾病状态下的治疗研究。
对于任何 Hcy 水平升高的患者，都应建议补充叶酸，并且应该在早期测量和治疗 Hcy 水平，因为叶酸容易获得，并且可能降低高危人群的血管疾病和其他有害病理过程的风险。
