title: The association of vitamin b 12 and folate blood levels with mortality and cardiovascular morbidity incidence in the old old: the Bronx aging study.
abstract: OBJECTIVE
  An elevated homocysteine level in the blood has been identified as an independent risk factor for vascular disease, including coronary atherosclerosis and venoembolic disease. A deficiency of vitamins B ( 6 ), B ( 12 ), or folate in the blood can cause increased blood levels of homocysteine. We set out to determine whether there was a relationship between blood levels of folate and B ( 12 ) and the subsequent development of cardiovascular disease and mortality in old old ambulatory men and women.
  
  
  METHODS
  Four hundred forty subjects (mean age, 79 years; 64% female) were followed in the Bronx Longitudinal Aging Study, a prospective study of 10 years duration, designed to assess risk factors for cardiovascular and cerebrovascular diseases and dementia in an ambulatory old old cohort.
  
  
  METHODS
  Serum levels of vitamin B ( 12 ) and folate were measured and related to the incidence of total all-cause mortality, stroke, myocardial infarction, coronary heart disease, and cardiovascular disease.
  
  
  RESULTS
  No statistical gender- or age-related differences were found in the mean levels of folate or B ( 12 ). The concentration of folate in the blood was not related to the incidence of mortality, myocardial infarction, stroke, or overall cardiovascular disease. However, by logistical regression and Cox proportional-hazards regression analyses, there was an increased incidence of mortality and coronary heart disease in those subjects having increased vitamin B ( 12 ) levels in the blood. Each 100-pg increase in B ( 12 ) was associated with a 10% increase in mortality and coronary heart disease incidence.
  
  
  CONCLUSIONS
  These results suggest that in elderly subjects, vitamin B ( 12 ) supplementation should not be routinely provided unless there are clear indications for doing so (a deficiency state), and then only to replace enough B ( 12 ) to correct the deficiency. A suggested treatment paradigm is provided for managing vitamin deficiency states and hyperhomocysteinemia in elderly subjects.
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Zeitlin
authors.forename: W H
authors.initials: WH
authors.lastname: Frishman
authors.forename: C J
authors.initials: CJ
authors.lastname: Chang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology*; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000097:blood*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality; D012044:Regression Analysis; D014805:Vitamin B 12 / Q000097:blood*
chemical_list: D005492:Folic Acid; D014805:Vitamin B 12