Background

A significant shift toward high folate concentrations has been taking place following the mandatory folate fortification. Yet the relationship between folate and health outcomes beyond neural tube defects remains understudied. We longitudinally examined relationships between serum folate and risk of cardiovascular death.

Methods

We analyzed data of 3116 adults aged ≥19 who participated in the Third National Health and Nutrition Examination Survey, 1991–1994 and were diagnosed with hypertension. Vital status was followed through December 31, 2010. Cox regression was used to estimate hazard ratios (HRs) of cardiovascular deaths for individuals with serum folate in the first quartile and fourth quartile compared with the patients with interquartile folate.

Results

After 33627 person years (p*ys) of follow-up, 1298 deaths were recorded with 638 cardiovascular disease (CVD) deaths (109 strokes and 529 heart diseases). A U-shaped association appeared after multivariable adjustment for heart disease, acute myocardial infarction, and overall CVD deaths. The mortality rate for heart disease in patients with low, moderate, and high folate were 12.18/1000 p*ys, 14.12/1000 p*ys, and 23.80/1000 p*ys, respectively, and the corresponding adjusted HRs were 1.79 (95% confidence interval, CI = 1.63–1.98), 1.00 (reference), and 1.31 (1.17–1.46). The HRs of acute myocardial infarction were 2.28 (1.80–2.88), 1.00 (reference), and 1.77 (1.42–2.20) for hypertensive patients with serum folate in low quartile, interquartile, and high quartile, respectively.

Conclusions

Among hypertensive adults, both low and high folate were associated with an elevated risk of dying from cardiovascular diseases compared with adults with moderate serum folate concentration.

中文翻译：

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成人高血压患者血清叶酸与心血管死亡之间的关联。

背景

在强制叶酸强化后，已经发生了向高叶酸浓度的重大转变。然而，叶酸与神经管缺陷以外的健康结果之间的关系仍未得到充分研究。我们纵向研究了血清叶酸与心血管死亡风险之间的关系。

方法

我们分析了 1991 年至 1994 年参加第三次全国健康与营养调查并被诊断患有高血压的 3116 名 19 岁以上成年人的数据。生命状态追踪至2010年12月31日。Cox回归用于评估血清叶酸含量在第一四分位和第四四分位的个体与四分位间叶酸患者相比的心血管死亡风险比(HR)。

结果

经过 33627 人年 (p*ys) 的随访，记录了 1298 例死亡，其中 638 例死于心血管疾病 (CVD)（109 例中风和 529 例心脏病）。对心脏病、急性心肌梗塞和总体心血管疾病死亡进行多变量调整后，出现 U 形关联。低叶酸、中叶酸和高叶酸患者的心脏病死亡率分别为 12.18/1000 p*ys、14.12/1000 p*ys 和 23.80/1000 p*ys，相应的调整后 HR 为 1.79 (95 % 置信区间，CI = 1.63–1.98)、1.00（参考）和 1.31 (1.17–1.46)。血清叶酸水平处于低四分位、四分位间和高四分位的高血压患者急性心肌梗死的 HR 分别为 2.28（1.80-2.88）、1.00（参考）和 1.77（1.42-2.20）。

结论

在高血压成人中，与血清叶酸浓度适中的成人相比，低叶酸和高叶酸均与心血管疾病死亡风险升高相关。