CHAPTER 3: Vitamins and Folate Fortification in the Context of Cardiovascular Disease Prevention

The role of B vitamins in the prevention of cardiovascular disease has been extensively investigated during the last decade. Folic acid supplemented with B₁₂ and B₆ vitamins has been used in randomized clinical trials to lower plasma homocysteine, a biomarker closely related with increased cardiovascular risk. In this chapter we discuss the existing basic and clinical data on the role of B vitamins in cardiovascular disease. We focus on the homocysteine lowering B vitamins (folic acid, B₆ and B₁₂). We review the beneficial cardiovascular effects of B vitamins per se at a molecular level as well as the lessons learned from clinical trials. We discuss recent concerns over B vitamin administration at pharmacological doses and the issue of folate fortification in the context of cardiovascular disease prevention. Clinical trials have failed to provide any strong evidence in favour of the use of B vitamins in cardiovascular disease prevention. However, the positive mechanistic data mandate closer investigation of the role of B vitamins in cardiovascular physiology.