© 2001 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Renal Insufficiency, Vitamin B12 Status, and Population Attributable Risk for Mild Hyperhomocysteinemia Among Coronary Artery Disease Patients in the Era of Folic Acid–Fortified Cereal Grain Flour
From the Division of General Internal Medicine (G.L., A.G.B.), Memorial Hospital of Rhode Island, Providence, and the Tufts Jean Mayer USDA Human Nutrition Research Center on Aging (P.F.J., J.S., I.H.R., A.G.B.), Boston, Mass.
Abstract—Fortification
of enriched cereal grain flour products with folic acid has
drastically reduced the prevalence of deficient plasma folate status, a
major determinant of plasma total homocysteine (tHcy) levels. We
hypothesized that even more liberally defined "suboptimal" plasma
folate status might no longer contribute importantly to the population
attributable risk (PAR) for mild hyperhomocysteinemia, a putative
atherothrombotic risk factor. We determined fasting plasma tHcy,
folate, vitamin B12, and pyridoxal 5'-phosphate
levels, along with serum creatinine and albumin
levels, in 267 consecutive patients (aged 61±9 [mean±SD] years,
76.4% men and 26.6% women) with stable coronary artery
disease (CAD) who were nonusers of vitamin supplements or had
abstained from supplement use for at least 6 weeks before examination.
Subjects were evaluated a minimum of 3 months after the implementation
of flour fortification was largely completed. Relative risk estimates
for the calculation of PAR were derived from a
multivariable-adjusted logistic regression model with 
12 µmol/L
tHcy as the dependent variable and with age, sex, pyridoxal
5'-phosphate (continuous), albumin (continuous), <5 ng/mL
folate, <250 pg/mL vitamin B12, and 1.3 mg/dL
creatinine as the independent variables. The prevalence
of 12 µmol/L plasma tHcy was 11.2% (30 of 267 patients). PAR
estimates (percentage) for 12 µmol/L tHcy were as follows: <5
ng/mL folate (<1%), <250 pg/mL vitamin B12
(24.5%), and 1.3 mg/dL creatinine (37.5%). In the era
of folic acid–fortified cereal grain flour, renal insufficiency and
suboptimal vitamin B12 status (but not folate
status) contribute importantly to the PAR for mild hyperhomocysteinemia
among patients with stable
CAD.
Key Words: coronary arteriosclerosis • renal function • homocysteine • determinants
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