Research Article| Volume 27, ISSUE 11, P1015-1020, November 2017

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Red blood cell folate concentrations and coronary heart disease prevalence: A cross-sectional study based on 1999–2012 National Health and Nutrition Examination Survey

  • Y. Peng
    Corresponding author. Level 8, UQ Health Sciences Building, University of Queensland, Herston, Queensland, Australia. Fax: +61 7 33465178.
    Centre for Chronic Disease, Centre for Clinical Research, The University of Queensland, Herston, Queensland 4029, Australia
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  • Z. Wang
    Centre for Chronic Disease, Centre for Clinical Research, The University of Queensland, Herston, Queensland 4029, Australia
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      • Higher RBC folate concentrations were significantly associated with an elevated risk of CHD.
      • The association was independent of traditional CHD risk factors.
      • The positive RBC folate–CHD relationship is more apparent in male than female.


      Background and aim

      Folate is involved in a number of metabolic pathways. Red blood cell (RBC) folate is a well-established indicator of folate intake. However, studies focused on the association between RBC folate and coronary heart disease (CHD) are limited. The aim of the current study was to investigate the effect of RBC folate concentrations on the presence of CHD in a nationally representative sample of American adults.

      Methods and results

      In the 1999–2012 National Health and Nutrition Examination Survey (NHANES), 22,499 subjects aged 30–74 years with RBC folate concentrations, CHD status and responses to co-variates questions were included; 822 (3.65%) participants were identified as having CHD. Bio-Rad Quanta Phase II radioassay and microbiological assay were used to measure RBC folate concentrations. Firstly, we treated RBC folate as a categorical variable, based on RBC folate tertiles, and used logistic regression analysis to display the RBC folate and CHD relationship. Secondly, we explored associations using a combination of restricted cubic spline and logistic regression models, stratified by sex. After adjusting for several well-established traditional CHD risk factors, RBC folate was positively related to CHD presence in the total population and the association was more pronounced among males than females. A J-shaped pattern was observed in RBC folate concentrations for females.


      Elevated RBC folate concentrations were associated with higher CHD risk. Further investigation is needed to test the association in large-scale follow-up studies.


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