title: Vitamin B12 and folate deficiency in chronic heart failure.
abstract: OBJECTIVE
  To determine the prevalence, clinical correlates and the effects on outcome of vitamin B12 and folic acid levels in patients with chronic heart failure (HF).
  
  
  METHODS
  We studied an international pooled cohort comprising 610 patients with chronic HF. The main outcome measure was all-cause mortality.
  
  
  RESULTS
  Mean age of the patients was 68±12 years and median serum N-terminal prohormone brain natriuretic peptide level was 1801 pg/mL (IQR 705-4335). Thirteen per cent of the patients had an LVEF >45%. Vitamin B12 deficiency (serum level <200 pg/mL), folate deficiency (serum level <4.0 ng/mL) and iron deficiency (serum ferritin level <100 µg/L, or 100-299 µg/L with a transferrin saturation <20%) were present in 5%, 4% and 58% of the patients, respectively. No significant correlation between mean corpuscular volume and vitamin B12, folic acid or ferritin levels was observed. Lower folate levels were associated with an impaired health-related quality of life (p=0.029). During a median follow-up of 2.10 years (1.31-3.60 years), 254 subjects died. In multivariable proportional hazard models, vitamin B12 and folic acid levels were not associated with prognosis.
  
  
  CONCLUSIONS
  Vitamin B12 and folate deficiency are relatively rare in patients with chronic HF. Since no significant association was observed between mean corpuscular volume and neither vitamin B12 nor folic acid levels, this cellular index should be used with caution in the differential diagnosis of anaemia in patients with chronic HF. In contrast to iron deficiency, vitamin B12 and folic acid levels were not related to prognosis.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Haye H
authors.initials: HH
authors.lastname: van der Wal
authors.affiliation: Heart Failure Program, Hospital del Mar and Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Comin-Colet
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Ijsbrand T
authors.initials: IT
authors.lastname: Klip
authors.affiliation: Heart Failure Program, Hospital del Mar and Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Enjuanes
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Niels
authors.initials: N
authors.lastname: Grote Beverborg
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.affiliation: Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Banasiak
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Heart Failure Program, Hospital del Mar and Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bruguera
authors.affiliation: Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland Cardiology Department, Military Hospital, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.affiliation: Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland Cardiology Department, Military Hospital, Wroclaw, Poland.
authors.forename: Ewa A
authors.initials: EA
authors.lastname: Jankowska
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: van der Meer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D004909:Erythrocyte Indices; D005060:Europe / Q000453:epidemiology; D005260:Female; D005293:Ferritins / Q000097:blood; D005494:Folic Acid Deficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007501:Iron / Q000097:blood; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D011788:Quality of Life; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D014168:Transferrin / Q000378:metabolism; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D014805:Vitamin B 12 / Q000097:blood; D014806:Vitamin B 12 Deficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D014168:Transferrin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D005293:Ferritins; D007501:Iron; D014805:Vitamin B 12
keywords: HEART FAILURE