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Serum folate and cardiovascular disease mortality among US men and women
C M Loria1, D D Ingram, J J Feldman
1Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, 6701 Rockledge Dr, Room 8150, Bethesda, MD 20892-7934, USA. loriac@nih.gov
Background:
Folate has been linked to cardiovascular disease (CVD) through its role in homocysteine metabolism.
Objective:
To assess the relationship between serum folate and CVD mortality.
Design:
In this prospective study, serum folate concentrations were measured on a subset of adults during the Second National Health and Nutrition Examination Survey (1976-1980) and vital status ascertained after 12 to 16 years.
Setting And Patients:
A national probability sample consisting of 689 adults who were 30 to 75 years of age and did not have a history of CVD at baseline.
Main Outcome Measure:
Vital status was determined by searching national databases that contained information about US decedents.
Results:
The associations between serum folate and CVD and all-cause mortality differed by diabetes status (P =.04 and P =.03, respectively). Participants without diabetes in the lowest compared with the highest serum folate tertile had more than twice the risk of CVD mortality after adjustment for age and sex (relative risk [RR], 2.64; 95% confidence interval [CI], 1.15-6.09). This increased risk for participants in the lowest tertile was attenuated after adjustment for CVD risk factors (RR, 2.28; 95% CI, 0.96-5.40). Serum folate tertiles were not significantly associated with total mortality, although the age- and sex-adjusted risk was increased for participants in the lowest compared with highest tertile (RR, 1.74; 95% CI, 0.96-3.15). Risk estimates for participants with diabetes were unstable because of the small sample size (n = 52).
Conclusion:
These data suggest that low serum folate concentrations are associated with an increased risk of CVD mortality among adults who do not have diabetes. Arch Intern Med. 2000;160:3258-3262.
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