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Evidence for a protective (synergistic?) effect of B-vitamins and omega-3 fatty acids on cardiovascular diseases

Abstract

The results of dietary intervention trials favor the hypothesis that higher intakes of B-vitamins (folate, vitamin B6 and B12), and subsequently lower total homocysteine (tHcy) concentrations, are causally associated with a decreased risk of vascular disease in patients with cardiovascular diseases (CVD). The same is true for a higher intake of omega-3 fish fatty acids. Yet, the lack of hard end points and/or appropriate study designs precludes a definitive conclusion about causality. In the future, intervention trials with hard end points and randomized double-blind placebo-controlled designs should be able to elucidate the causality problem. There are several pathways by which B-vitamins and omega-3 fatty acids may exert their protective effect on CVD, a common pathway is a beneficial effect on the endothelial function and hemostasis. With respect to synergy between B-vitamins and omega-3 fatty acids, there is no evidence that fish oils have a tHcy-lowering effect beyond the effect of the B-vitamins. Nevertheless, animal studies clearly illustrate that vitamin B6- as well as folate-metabolism are linked with those of long-chain omega-3 fatty acids. Furthermore, a human study indicated synergistic effects of folic acid (synthetic form of folate) and vitamin B6 together with omega-3 fatty acids on the atherogenic index and the fibrinogen concentration. Although these results are promising, they were produced in very small selective study populations. Thus, confirmation in large well-designed intervention trials is warranted.

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References

  • Albert CM, Hennekens CH, O’Donnell CJ, Ajani UA, Carey VJ, Willett WC, Ruskin JN & Manson JE (1998): Fish consumption and risk of sudden cardiac death. JAMA 279, 23–28.

    CAS  Article  Google Scholar 

  • Bang HO, Dyerberg J & Sinclair H M (1980): The composition of the Eskimo food in North Western Greenland. Am. J. Clin. Nutr. 33, 2657–2661.

    CAS  Article  Google Scholar 

  • Bates CJ, Mansoor MA, vanderPols J, Prentice A, Cole TJ & Finch S (1997): Plasma total homocysteine in a representative sample of 972 British men and women aged 65 and over. Eur. J. Clin. Nutr. 51, 691–697.

    CAS  Article  Google Scholar 

  • Bergami R, Maranesi M, Marchetti M, Sangiorgi Z & Tolomelli B (1999): Influence of Dietary N-3 polyunsaturated fatty acids on plasma lipemic effect of vitamin B6 deficiency. Int. J. Vitam. Nutr. Res. 69, 315–321.

    CAS  Article  Google Scholar 

  • Bostom AG & Garber C (2000): Endpoints for homocysteine-lowering trials. Lancet 355, 511–512 (Comment).

    CAS  Article  Google Scholar 

  • Boushey CJ, Beresford SA, Omenn GS & Motulsky AG (1995): A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. JAMA 274, 1049–1057.

    CAS  Article  Google Scholar 

  • Brown AA & Hu FB (2001): Dietary modulation of endothelial function: Implications for cardiovascular disease. Am. J. Clin. Nutr. 73, 673–686.

    CAS  Article  Google Scholar 

  • Brude IR, Finstad HS, Seljeflot I, Drevon CA, Solvoll K, Sandstad B, Hjermann I, Arnesen H & Nenseter MS (1999): Plasma homocysteine concentration related to diet, endothelial function and mononuclear cell gene expression among male hyperlipidaemic smokers. Eur. J. Clin. Invest. 29, 100–108.

    CAS  Article  Google Scholar 

  • Bucher HC, Hengstler P, Schindler C & Meier G (2002): N-3 polyunsaturated fatty acids in coronary heart disease: a meta- analysis of randomized controlled trials. Am. J. Med. 112, 298–304.

    CAS  Article  Google Scholar 

  • Burr ML, Fehily AM, Gilbert JF, Rogers S, Holliday RM, Sweetnam PM, Elwood PC & Deadman NM (1989a): Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet 2, 757–761.

    CAS  Article  Google Scholar 

  • Burr ML, Fehily AM, Rogers S, Welsby E, King S & Sandham S (1989b): Diet and Reinfarction Trial (DART): design, recruitment, and compliance. Eur. Heart. J. 10, 558–567.

    CAS  Article  Google Scholar 

  • Cabrini L, Bergami R, Maranesi M, Carloni A, Marchetti M & Tolomelli B (2001): Effects of short-term dietary administration of marginal levels of vitamin B(6)and fish oil on lipid composition and antioxidant defences in rat tissues. Prostaglandins Leukot. Essent. Fatty Acids 64, 265–271.

    CAS  Article  Google Scholar 

  • Chasan Taber L, Selhub J, Rosenberg IH, Malinow MR, Terry P, Tishler PV, Willett W, Hennekens CH & Stampfer MJ (1996): A prospective study of folate and vitamin B6 and risk of myocardial infarction in US physicians. J. Am. Coll. Nutr. 15, 136–143.

    CAS  Article  Google Scholar 

  • Clarke R & Armitage J (2000): Vitamin supplements and cardiovascular risk: review of the randomized trials of homocysteine-lowering vitamin supplements. Semin. Thromb. Hemost. 26, 341–348.

    CAS  Article  Google Scholar 

  • Cosentino F, Rubattu S, Savoia C, Venturelli V, Pagannonne E & Volpe M (2001): Endothelial dysfunction and stroke. J. Cardiovasc. Pharmacol. 38 (Suppl 2), S75–S78.

    CAS  Article  Google Scholar 

  • de Bree A, Verschuren WM, Blom HJ & Kromhout D (2001): Association between B vitamin intake and plasma homocysteine concentration in the general Dutch population aged 20–65 y. Am. J. Clin. Nutr. 73, 1027–1033.

    CAS  Article  Google Scholar 

  • de Jong SC, Stehouwer CD, van den BM, Geurts TW, Bouter LM & Rauwerda JA (1999): Normohomocysteinaemia and vitamin-treated hyperhomocysteinaemia are associated with similar risks of cardiovascular events in patients with premature peripheral arterial occlusive disease. A prospective cohort study. J. Intern. Med. 246, 87–96.

    CAS  Article  Google Scholar 

  • de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J & Mamelle N (1999): Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 99, 779–785.

    CAS  Article  Google Scholar 

  • De Vriese AS, Verbeke F, Schrijvers BF & Lameire NH (2002): Is folate a promising agent in the prevention and treatment of cardiovascular disease in patients with renal failure? Kidney Int. 61, 1199–1209.

    CAS  Article  Google Scholar 

  • Dolecek TA & Grandits G (1991): Dietary polyunsaturated fatty acids and mortality in the multiple risk factor intervention trial. World Rev. Nutr. Diet. 66, 205–216.

    CAS  Article  Google Scholar 

  • Durand P, Prost M & Blache D (1996): Pro-thrombotic effects of a folic acid deficient diet in rat platelets and macrophages related to elevated homocysteine and decreased N-3 polyunsaturated fatty acids. Atherosclerosis 121, 231–243.

    CAS  Article  Google Scholar 

  • Dyerberg J & Bang HO (1982): A hypothesis on the development of acute myocardial infarction in Greenlanders. Scand. J. Clin. Lab. Invest. Suppl. 161, 7–13.

    CAS  Article  Google Scholar 

  • Finkelstein JD (1990): Methionine metabolism in mammals. J. Nutr. Biochem. 1, 228–237.

    CAS  Article  Google Scholar 

  • Folsom AR, Nieto FJ, McGovern PG, Tsai MY, Malinow MR, Eckfeldt JH, Hess DL & Davis CE (1998): Prospective study of coronary heart disease incidence in relation to fasting total homocysteine, related genetic polymorphisms, and B vitamins: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation 98, 204–210.

    CAS  Article  Google Scholar 

  • Ford ES, Byers TE & Giles WH (1998): Serum folate and chronic disease risk: findings from a cohort of United States adults. Int. J. Epidermiol. 27, 592–598.

    CAS  Article  Google Scholar 

  • Ford ES, Smith SJ, Stroup DF, Steinberg KK, Mueller PW & Thacker SB (2002): Homocyst(e)Ine and cardiovascular disease: a systematic review of the evidence with special emphasis on case–control studies and nested case–control studies. Int. J. Epidemiol. 31, 59–70.

    Article  Google Scholar 

  • Giles WH, Kittner SJ, Croft JB, Anda RF, Casper ML & Ford ES (1998): Serum folate and risk for coronary heart disease: results from a cohort of US adults. Ann. Epidemiol. 8, 490–496.

    CAS  Article  Google Scholar 

  • Gissi Prevenzione (1999): Dietary supplementation with N-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano Per Lo Studio Della Sopravvivenza Nell’Infarto Miocardico. Lancet 354, 447–455.

  • Grundt H, Nilsen DW, Hetland O, Mansoor MA, Aarsland T & Woie L (1999): Atherothrombogenic risk modulation by N-3 fatty acids was not associated with changes in homocysteine in subjects with combined hyperlipidaemia. Thromb. Haemost. 81, 561–565.

    CAS  PubMed  Google Scholar 

  • Guenther BD, Sheppard CA, Tran P, Rozen R, Matthews RG & Ludwig ML (1999): The structure and properties of methylenetetrahydrofolate reductase from Escherichia coli suggest how folate ameliorates human hyperhomocysteinemia. Nat. Struct. Biol. 6, 359–365.

    CAS  Article  Google Scholar 

  • Hackam DG, Peterson JC & Spence JD (2000): What level of plasma homocyst(e)Ine should be treated? Effects of vitamin therapy on progression of carotid atherosclerosis in patients with homocyst(e)Ine levels above and below 14 micromol/l. Am. J. Hypertens. 13, 105–110.

    CAS  Article  Google Scholar 

  • Haglund O, Hamfelt A, Hambraeus L & Saldeen T (1993): Effects of fish oil supplemented with pyrodoxine and folic acid on triglycerides, glucose, homocysteine and fybrinolysis in Man. Nutr. Res. 13, 1351–1365.

    CAS  Article  Google Scholar 

  • Haglund O, Wallin R, Wretling S, Hultberg B & Saldeen T (1998): Effects of fish oil alone and combined with long chain (n-6) fatty acids on some coronary risk factors in male subjects. J. Nutr. Biochem. 9, 629–635.

    CAS  Article  Google Scholar 

  • Harris WS (1997): N-3 fatty acids and serum lipoproteins: human studies. Am. J. Clin. Nutr. 65, 1645S–1654S.

    CAS  Article  Google Scholar 

  • Hirose S, Kim S, Matsuda A, Itakura Y, Matsumura O, Tamura H, Nagasawa R, Mitarai T & Isoda K (1998): Effects of folic acid supplementation on hyperhomocysteinemia in CAPD patients: effects on unsaturated fatty acids. Nippon Jinzo Gakkai Shi 40, 8–16.

    CAS  PubMed  Google Scholar 

  • Holdt B, Korten G, Knippel M, Lehmann JK, Claus R, Holtz M & Hausmann S (1996): Increased serum level of total homocysteine in CAPD patients despite fish oil therapy. Perit. Dial. Int. 16 (Suppl 1), S246–S249.

    PubMed  Google Scholar 

  • Hu FB, Bronner L, Willett WC, Stampfer MJ, Rexrode KM, Albert CM, Hunter D & Manson JE (2002): Fish and Omega-3 fatty acid intake and risk of coronary heart disease in women. JAMA 287, 1815–1821.

    CAS  Article  Google Scholar 

  • Jacques PF, Bostom AG, Wilson PW, Rich S, Rosenberg IH & Selhub J (2001): Determinants of plasma total homocysteine concentration in the Framingham Offspring Cohort. Am. J. Clin. Nutr. 73, 613–621.

    CAS  Article  Google Scholar 

  • Jia L & Furchgott RF (1993): Inhibition by sulfhydryl compounds of vascular relaxation induced by nitric oxide and endothelium-derived relaxing factor. J. Pharmacol. Exp. Ther. 267, 371–378.

    CAS  PubMed  Google Scholar 

  • Kang JX & Leaf A (2000): Prevention of fatal cardiac arrhythmias by polyunsaturated fatty acids. Am. J. Clin. Nutr. 71, 202S–207S.

    CAS  Article  Google Scholar 

  • Koehler KM, Baumgartner RN, Garry PJ, Allen RH, Stabler SP & Rimm EB (2001): Association of folate intake and serum homocysteine in elderly persons according to vitamin supplementation and alcohol use. Am. J. Clin. Nutr. 73, 628–637.

    CAS  Article  Google Scholar 

  • Leaf A & Weber PC (1988): Cardiovascular effects of N-3 fatty acids. N. Engl. J. Med. 318, 549–557.

    CAS  Article  Google Scholar 

  • Loria CM, Ingram DD, Feldman JJ, Wright JD & Madans JH (2000): Serum folate and cardiovascular disease mortality among US men and women. Arch. Intern. Med. 160, 3258–3262.

    CAS  Article  Google Scholar 

  • Loscalzo J (1996): The oxidant stress of hyperhomocyst(e)Inemia. J. Clin. Invest. 98, 5–7.

    CAS  Article  Google Scholar 

  • McDowell IF & Lang D (2000): Homocysteine and endothelial dysfunction: a link with cardiovascular disease. J. Nutr. 130, 369S–372S.

    CAS  Article  Google Scholar 

  • Moller JM, Nielsen GL, Ekelund S, Schmidt EB & Dyerberg J (1997): Homocysteine in Greenland inuits. Thromb. Res. 86, 333–335.

    CAS  Article  Google Scholar 

  • Morrison HI, Schaubel D, Desmeules M & Wigle DT (1996): Serum folate and risk of fatal coronary heart disease. JAMA 275, 1893–1896.

    CAS  Article  Google Scholar 

  • Mueller JF & Iacono JM (1963): Effect of desoxypyridoxine-induced vitamin B6 deficiency on polyunsaturated fatty acid metabolism in human beings. Am. J. Clin. Nutr. 12, 358–367.

    CAS  Article  Google Scholar 

  • Nair SS, Leitch JW, Falconer J & Garg ML (1997): Prevention of cardiac arrhythmia by dietary (n-3) polyunsaturated fatty acids and their mechanism of action. J. Nutr. 127, 383–393.

    CAS  Article  Google Scholar 

  • Nenseter MS, Osterud B, Larsen T, Strom E, Bergei C, Hewitt S, Holven KB, Hagve TA, Mjos SA, Solvang M, Pettersen J, Opstvedt J & Ose L (2000): Effect of Norwegian fish powder on risk factors for coronary heart disease among hypercholesterolemic individuals. Nutr. Metab. Cardiovasc. Dis. 10, 323–330.

    CAS  PubMed  Google Scholar 

  • Nilsen DW, Albrektsen G, Landmark K, Moen S, Aarsland T & Woie L (2001): Effects of a high-dose concentrate of N-3 fatty acids or corn oil introduced early after an acute myocardial infarction on serum triacylglycerol and HDL cholesterol. Am. J. Clin. Nutr. 74, 50–56.

    CAS  Article  Google Scholar 

  • Olszewski AJ & McCully KS (1993): Fish oil decreases serum homocysteine in hyperlipemic men. Coronary Artery. Dis. 4, 53–60.

    CAS  Article  Google Scholar 

  • Passmore R & Eastwood MA (1986): Fats. In Human Nutrition and Dietetics eds GP Davidson & R Passmore, pp 54–69. Edinburg: Churchill Livingstone.

    Google Scholar 

  • Piolot A, Blache D, Boulet L, Fortin LJ, Dubreuil D, Marcoux C, Davignon J & Lussier-Cacan S (2003): Effect of fish oil on LDL oxidation and plasma homocysteine concentrations in health. J. Lab. Clin. Med. 141, 41–49.

    CAS  Article  Google Scholar 

  • Pita ML & Delgado MJ (2000): Folate administration increases N-3 polyunsaturated fatty acids in rat plasma and tissue lipids. Thromb. Haemost. 84, 420–423.

    CAS  Article  Google Scholar 

  • Rasmussen K, Moller J, Lyngbak M, Pedersen AM & Dybkjaer L (1996): Age- and gender-specific reference intervals for total homocysteine and methylmalonic acid in plasma before and after vitamin supplementation. Clin. Chem. 42, 630–636.

    CAS  PubMed  Google Scholar 

  • Rasmussen LB, Ovesen L, Bulow I, Knudsen N, Laurberg P & Perrild H (2000): Folate intake, lifestyle factors, and homocysteine concentrations in younger and older women. Am. J. Clin. Nutr. 72, 1156–1163.

    CAS  Article  Google Scholar 

  • Saw SM, Yuan JM, Ong CN, Arakawa K, Lee HP, Coetzee GA & Yu MC (2001): Genetic, dietary, and other lifestyle determinants of plasma homocysteine concentrations in middle-aged and older chinese men and women in Singapore. Am. J. Clin. Nutr. 73, 232–239.

    CAS  Article  Google Scholar 

  • Schnyder G, Roffi M, Flammer Y, Pin R & Hess OM (2002): Effect of homocysteine-lowering therapy with folic acid, vitamin B(12), and vitamin B(6) on clinical outcome after percutaneous coronary intervention: the Swiss Heart Study: a Randomized Controlled Trial. JAMA 288, 973–979.

    CAS  Article  Google Scholar 

  • Selhub J, Jacques PF, Wilson PW, Rush D & Rosenberg IH (1993): Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. JAMA 270, 2693–2698.

    CAS  Article  Google Scholar 

  • Shimakawa T, Nieto FJ, Malinow MR, Chambless LE, Schreiner PJ & Szklo M (1997): Vitamin intake: a possible determinant of plasma homocyst(e)Ine among middle-aged adults. Ann. Epi. 7, 285–293.

    CAS  Article  Google Scholar 

  • Singh RB, Niaz MA, Sharma JP, Kumar R, Rastogi V & Moshiri M (1997): Randomized, double-blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian Experiment of Infarct Survival. Cardiovasc. Drugs Ther. 11, 485–491.

    CAS  Article  Google Scholar 

  • Stamler JS, Osborne JA, Jaraki O, Rabbani LE, Mullins M, Singel D & Loscalzo J (1993): Adverse vascular effects of homocysteine are modulated by endothelium- derived relaxing factor and related oxides of nitrogen. J. Clin. Invest. 91, 308–318.

    CAS  Article  Google Scholar 

  • Starkebaum G & Harlan JM (1986): Endothelial cell injury due to copper-catalyzed hydrogen peroxide generation from homocysteine. J. Clin. Invest. 77, 1370–1376.

    CAS  Article  Google Scholar 

  • Stroes ES, van Faassen EE, Yo M, Martasek P, Boer P, Govers R & Rabelink TJ (2000): Folic acid reverts dysfunction of endothelial nitric oxide synthase. Circ. Res. 86, 1129–1134.

    CAS  Article  Google Scholar 

  • Sugiyama K, Kumazawa A, Zhou H & Saeki S (1998): Dietary methionine level affects linoleic acid metabolism through phosphatidylethanolamine N-methylation in rats. Lipids 33, 235–242.

    CAS  Article  Google Scholar 

  • Thambyrajah J & Townend JN (2000): Homocysteine and atherothrombosis—mechanisms for injury. Eur. Heart. J. 21, 967–974.

    CAS  Article  Google Scholar 

  • The Homocysteine Studies Collaboration (2002): Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. JAMA 288, 2015–2022.

    Article  Google Scholar 

  • Tsuge H, Hotta N & Hayakawa T (2000): Effects of vitamin B-6 on (n-3) polyunsaturated fatty acid metabolism. J. Nutr. 130, 333S–334S.

    CAS  Article  Google Scholar 

  • Ubbink JB, Fehily AM, Pickering J, Elwood PC & Vermaak WJH (1998): Homocysteine and ischaemic heart disease in the Caerphilly cohort. Atherosclerosis 140, 349–356.

    CAS  Article  Google Scholar 

  • Ueland PM, Refsum H, Beresford SA & Vollset SE (2000): The controversy over homocysteine and cardiovascular risk. Am. J. Clin. Nutr. 72, 324–332.

    CAS  Article  Google Scholar 

  • Upchurch Jr GR, Welch GN, Fabian AJ, Freedman JE, Johnson JL, Keaney Jr JF & Loscalzo J (1997): Homocyst(e)Ine decreases bioavailable nitric oxide by a mechanism involving glutathione peroxidase. J. Biol. Chem. 272, 17012–17017.

    CAS  Article  Google Scholar 

  • Upchurch Jr GR, Welch GN & Loscalzo J (1996): Homocysteine, EDRF, and endothelial function. J. Nutr. 126, 1290S–1294S.

    CAS  Article  Google Scholar 

  • Verhaar MC, Wever RM, Kastelein JJ, van Dam T, Koomans HA & Rabelink TJ (1998): 5-Methyltetrahydrofolate, the active form of folic acid, restores endothelial function in familial hypercholesterolemia. Circulation 97, 237–241.

    CAS  Article  Google Scholar 

  • Verhaar MC, Wever RM, Kastelein JJ, van Loon D, Milstien S, Koomans HA & Rabelink TJ (1999): Effects of oral folic acid supplementation on endothelial function in familial hypercholesterolemia. A randomized placebo-controlled trial. Circulation 100, 335–338.

    CAS  Article  Google Scholar 

  • Vermeulen EG, Rauwerda JA, Erix P, de Jong SC, Twisk JW, Jakobs C, Witjes RJ & Stehouwer CD (2000a): Normohomocysteinaemia and vitamin-treated hyperhomocysteinaemia are associated with similar risks of cardiovascular events in patients with premature atherothrombotic cerebrovascular disease. A Prospective Cohort Study. Neth. J. Med. 56, 138–146.

    CAS  Article  Google Scholar 

  • Vermeulen EGJ, Stehouwer CDA, Twisk JWR, van den BM, de Jong SC, Mackaay AJC, van Campen CMC, Visser FC, Jakobs CAJM, Bulterijs EJ & Rauwerda JA (2000b): Effect of homocysteine-lowering treatment with folic acid plus vitamin B-6 on progression of subclinical atherosclerosis: a randomised, placebo-controlled trial. Lancet 355, 517–522.

    CAS  Article  Google Scholar 

  • von Schacky C (2000): N-3 fatty acids and the prevention of coronary atherosclerosis. Am. J. Clin. Nutr. 71, 224S–227S.

    CAS  Article  Google Scholar 

  • Voutilainen S, Lakka TA, Porkkala SE, Rissanen T, Kaplan GA & Salonen JT (2000): Low serum folate concentrations are associated with an excess incidence of acute coronary events: the Kuopio Ischaemic Heart Disease Risk Factor Study. Eur. J. Clin. Nutr. 54, 424–428.

    CAS  Article  Google Scholar 

  • Wald DS, Law M & Morris JK (2002): Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. BMJ 325, 1202.

    Article  Google Scholar 

  • Zeitlin A, Frishman WH & Chang CJ (1997): The association of vitamin B12 and folate blood levels with mortality and cardiovascular morbidity incidence in the old: the Bronx Aging Study. Am. J. Ther. 4, 275–281.

    CAS  Article  Google Scholar 

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Contributors: AdB was responsible for the study concept, the literature search and the writing of the manuscript. LIM, PG and SH were responsible for critical revision of the manuscript for important intellectual content.

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de Bree, A., Mennen, L., Hercberg, S. et al. Evidence for a protective (synergistic?) effect of B-vitamins and omega-3 fatty acids on cardiovascular diseases. Eur J Clin Nutr 58, 732–744 (2004). https://doi.org/10.1038/sj.ejcn.1601871

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Keywords

  • omega-3 fatty acids
  • vitamin B6
  • vitamin B12
  • homocysteine
  • folic acid
  • cardiovascular diseases

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