Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Vitamin B9, particularly in its active form as L-methyltetrahydrofolate (5-MTHF), has scientific support for its use in cardiovascular disease, mainly due to its role in homocysteine metabolism. Elevated levels of homocysteine are an established risk factor for cardiovascular events such as heart attack and stroke. Folate (B9), along with vitamins B6 and B12, is essential for the conversion of homocysteine to methionine, thereby lowering plasma homocysteine levels.

Several randomized controlled trials and meta-analyses have shown that folic acid and 5-MTHF supplementation can effectively reduce homocysteine concentrations. However, the evidence linking homocysteine reduction to actual decreases in cardiovascular events is mixed. Some observational studies and a few clinical trials (notably in populations with low baseline folate status) have suggested a benefit in reducing risk for stroke and other cardiovascular endpoints. For example, the China Stroke Primary Prevention Trial (CSPPT) found a modest reduction in stroke risk with folic acid supplementation in hypertensive adults.

Despite these findings, large trials in populations with adequate folate intake (such as in the US and Europe, where food is often fortified) have not demonstrated significant reductions in cardiovascular events with B-vitamin supplementation. Thus, while the biological rationale is clear and there is some evidence of benefit in specific populations, the overall evidence for cardiovascular disease prevention or treatment with B9 is moderate and context-dependent.

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