- •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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Published online: July 24, 2017
Accepted: July 17, 2017
Received in revised form: June 28, 2017
Received: June 1, 2017Handling Editor: F. Galletti
© 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.