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Q J Med 2002; 95: 27-35
© 2002 Association of Physicians

The effect of folic acid supplementation on plasma homocysteine in an elderly population

A. Rydlewicz, J.A. Simpson, R.J. Taylor, C.M. Bond and M.H.N. Golden1

From the Departments of General Practice and Primary Care and 1 Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK

Received 9 May 2001 and in revised form 17 October 2001

Background: Increased plasma homocysteine is associated with coronary artery disease, peripheral vascular disease and venous thrombosis. Folic acid is the most effective therapy for reducing homocysteine levels. The lowest effective supplement of folic acid is not known, particularly for the elderly who have the highest prevalence of these conditions.

Aim: To explore the effects of daily supplements of 0, 50, 100, 200, 400 and 600 µg folic acid on plasma homocysteine in an elderly population.

Design: Randomized double-blind placebo-controlled trial.

Methods: Participants (n=368) aged 65–75 years were randomly allocated to receive one of the treatments for 6 weeks. Plasma homocysteine was recorded after 3 weeks and 6 weeks of supplementation.

Results: Only the 400 µg and 600 µg groups had significantly lower homocysteine levels compared to placebo (p=0.038 and p<0.001, respectively). Using multiple linear regression and each individual's total folic acid intake (diet plus supplement), a total daily folic acid intake of 926 µg per day would be required to ensure that 95% of the elderly population would be without cardiovascular risk from folate deficiency.

Discussion: A daily folic acid intake of 926 µg is unlikely to be achieved by diet alone. Individual supplementation or fortification of food with folic acid will be required to reach this target.

Address correspondence to Dr A. Rydlewicz, Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY. e-mail: a.rydlewicz{at}abdn.ac.uk


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