Mass supplementation of folate, vitamin B12 and vitamin B6 to reduce the burden of cardiovascular diseases in Pakistan

There is an emerging epidemic of cardiovascular diseases (CVD) in Pakistan. According to WHO, the burden of CVD is likely to increase further in Pakistan due to its aging population, urbanization and changing dietary habits. In 2003, UNICEF highlighted lack of information about folate and vitamin B12 deficiencies in Pakistani population as “gaps in research in Pakistan”.

 

A cross-sectional study conducted in an urban population in Karachi (n=872) revealed high prevalence of deficiencies of folate (27.5%), vitamin B12 (9.74 %) and vitamin B6 (33.7%) in normal healthy adults. Along with these micronutrient deficiencies, there was high prevalence (57%) of hyperhomocysteinemia (levels >15 µmol/l) - a risk factor for the development of CVD. Hyperhomocysteinemia was associated with male sex, folate deficiency, vitamin B12 deficiency and smoking. Three-week supplementation of vitamin B-deficient individuals with folate (5mg/day), vitamin B12 (0.5mg/day) and vitamin B6 (50 mg/day) resulted in significant lowering of plasma levels of homocysteine (37.2 %: p=0.01).

 

These results point towards enormity of the problem that exists in this part of the world and the need of public health initiatives for control and prevention of CVD in Pakistan. Fortification of staple food with folic acid has emerged as an important public health intervention to reduce the incidence of neural tube defect births and hyperhomocysteinemia in a number of countries. Pakistan has yet to make headway in this direction. Awareness of masses about this health issue through media along with evidence-based advocacy before policy-makers would be critical to address this emerging problem.

 

Recent advances in technology have facilitated genome-wide exploration of populations/families at a greater risk of developing hyperhomocysteinemia. Such genomic scan studies have a great promise in unraveling the genetic basis of CVD in Pakistani population. Evidence-based research of this kind is more likely to have an impact on public health and policy.