Vitamin B12, homocysteine and carotid plaque in the era of folic acid fortification of enriched cereal grain products.
BACKGROUND
Carotid plaque area is a strong predictor of cardiovascular events. High homocysteine levels, which are associated with plaque formation, can result from inadequate intake of folate and vitamin B12. Now that folic acid fortification is widespread in North America, vitamin B12 has become an important determinant of homocysteine levels. We sought to determine the prevalence of low serum levels of vitamin B12, and their relation to homocysteine levels and carotid plaque area among patients referred for treatment of vascular disease since folic acid fortification of enriched grain products.


METHODS
We evaluated 421 consecutive new patients with complete data whom we saw in our vascular disease prevention clinics between January 1998 and January 2002. We measured total carotid plaque area by ultrasound and determined homocysteine and serum vitamin B12 levels in all patients.


RESULTS
The patients, 215 men and 206 women, ranged in age from 37 to 90 years (mean 66 years). Most were taking medications for hypertension (67%) and dyslipidemia (62%). Seventy-three patients (17%) had vitamin B12 deficiency (vitamin B12 level < 258 pmol/L with homocysteine level > 14 mumol/L or methylmalonic acid level > 271 nmol/L). The mean area of carotid plaque was significantly larger among the group of patients whose vitamin B12 level was below the median of 253 pmol/L than among those whose vitamin B12 level was above the median: 1.36 (standard deviation [SD] 1.27) cm2 v. 1.09 (SD 1.0) cm2; p = 0.016.


CONCLUSIONS
Vitamin B12 deficiency is surprisingly common among patients with vascular disease, and, in the setting of folic acid fortification, low serum vitamin B12 levels are a major determinant of elevated homocysteine levels and increased carotid plaque area.
Robertson
Julie
J
Department of Family Medicine, McMaster University, Hamilton, Ont.
Iemolo
Francesco
F
Stabler
Sally P
SP
Allen
Robert H
RH
Spence
J David
JD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000503:physiopathology* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D002523:Edible Grain; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D005527:Food, Fortified; D006397:Hematinics / Q000008:administration & dosage*; D006711:Homocystine / Q000097:blood*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014805:Vitamin B 12 / Q000627:therapeutic use*; D014806:Vitamin B 12 Deficiency / Q000150:complications* / Q000453:epidemiology
D006397:Hematinics; D006711:Homocystine; D005492:Folic Acid; D014805:Vitamin B 12