Serum folate and cardiovascular disease mortality among US men and women.
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.


METHODS
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.


METHODS
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.


METHODS
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).


CONCLUSIONS
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.
Loria
C M
CM
Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, 6701 Rockledge Dr, Room 8150, Bethesda, MD 20892-7934, USA. loriac@nih.gov
Ingram
D D
DD
Feldman
J J
JJ
Wright
J D
JD
Madans
J H
JH
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications / Q000401:mortality*; D016001:Confidence Intervals; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D005492:Folic Acid / Q000097:blood*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D005492:Folic Acid