Folate, homocysteine, endothelial function and cardiovascular disease

J Nutr Biochem. 2004 Feb;15(2):64-79. doi: 10.1016/j.jnutbio.2003.08.010.


Evidence reported from numerous clinical studies over the past decade has revealed an association between increased plasma total homocysteine (tHcy) concentrations and cardiovascular disease (CVD). In addition, epidemiological studies have identified an inverse association between blood folate concentrations, folate intake and cardiovascular endpoints, that are independent of homocysteine. Folic acid supplementation can lower plasma tHcy concentrations safely and inexpensively. Furthermore, folic acid can reverse endothelial dysfunction observed in patients with CVD. This reversal in endothelial dysfunction with folic acid has been shown to be independent of plasma tHcy lowering, suggesting that folate has pleiotropic effects on the vasculature other than homocysteine lowering. In vitro evidence demonstrates that 5-methyltetrahydrofolate (5MeTHF) the main circulating metabolite of folate, can increase nitric oxide production and can directly scavenge superoxide radicals. The potential beneficial role of folic acid supplements on vascular disease are currently being tested in randomized placebo controlled studies.

Publication types

  • Review

MeSH terms

  • Antioxidants
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / physiopathology*
  • Endothelium, Vascular / drug effects
  • Endothelium, Vascular / physiopathology*
  • Folic Acid / adverse effects
  • Folic Acid / pharmacology
  • Folic Acid / physiology*
  • Folic Acid Deficiency / complications
  • Homocysteine / physiology*
  • Humans
  • Hyperhomocysteinemia / epidemiology
  • Hyperhomocysteinemia / etiology
  • Nitric Oxide Synthase / metabolism
  • Nitric Oxide Synthase Type III
  • Risk Factors
  • Vitamin B Complex / therapeutic use


  • Antioxidants
  • Homocysteine
  • Vitamin B Complex
  • Folic Acid
  • NOS3 protein, human
  • Nitric Oxide Synthase
  • Nitric Oxide Synthase Type III