Folate and risk of coronary heart disease: A meta-analysis of prospective studies

Wang, Z.-M.; Zhou, B.; Nie, Z.-L.; Gao, W.; Wang, Y.-S.; Zhao, H.; Zhu, J.; Yan, J.-J.; Yang, Z.-J.; Wang, L.-S.

doi:10.1016/j.numecd.2011.04.011

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Folate and risk of coronary heart disease: A meta-analysis of prospective studies

Z.-M. Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China
- Drs Ze-Mu Wang, Bo Zhou and Zhen-Lin Nie contributed equally to this work.
B. Zhou
- Jiangsu Center of Safety Evaluation for Drugs, Nanjing University of Technology, Nanjing, China
- Drs Ze-Mu Wang, Bo Zhou and Zhen-Lin Nie contributed equally to this work.
Z.-L. Nie
- Central Laboratory, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
- Drs Ze-Mu Wang, Bo Zhou and Zhen-Lin Nie contributed equally to this work.
W. Gao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China
Y.-S. Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China
H. Zhao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China
J. Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China
J.-J. Yan
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China
Z.-J. Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China
L.-S. Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China
- Corresponding author. Tel./fax: +86 25 83724440.

Received 11 February 2011; received in revised form 15 April 2011; accepted 19 April 2011. published online 19 September 2011.
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Abstract

Background and aims

Epidemiologic studies are inconsistent regarding the association between folate and coronary heart disease (CHD) risk. The aim was to perform a meta-analysis to determine whether an association exists between folate and total CHD endpoints in prospective studies.

Methods and results

We searched the PUBMED and EMBASE databases for studies conducted from 1966 through August 2010. Data were independently abstracted by 2 investigators using a standardized protocol. Study-specific risk estimates were combined by using a random effects model.

A total of 14 studies were included in the meta-analysis: 7 studies on dietary folate intake and 8 studies on blood folate levels. For dietary intake, the summary relative risk (RR) indicated a significant association between the highest folate intake and reduced risk of CHD (summary RR: 0.69; 95% CI: 0.60, 0.80). Furthermore, an increase in folate intake of 200 ug/day was associated with a 12% decrease in the risk of developing CHD (summary RR: 0.88; 95% CI: 0.82, 0.94). For blood folate levels, we also found a borderline inverse association of highest blood folate levels on CHD risk (summary RR: 0.74; 95% CI: 0.53, 1.02); our dose-response analysis indicated that an increment in blood folate levels of 5 mmol/l was associated with an 8% decrease in the risk of developing CHD (summary RR: 0.92; 95% CI: 0.84, 1.00).