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Folate Levels Protect from CV Mortality in RA

Mar 02, 2020 1:07 pm

In a study of rheumatoid arthritis (RA) patients, JAMA reports that serum folate level of greater than 4.3 ng/mL was associated with lower CV mortality risk.

A cohort study from the third National Health and Nutrition Examination Survey (1988-1994) and 2011 compared assess the risk of CV mortality in 683 RA patients based on their serum folate levels.

A total of 683 patients with RA had an average age 55.9 years; 30% were men and 87% were white and had a medial follow up of 17.4 years.  There were 392 total deaths and 258 CV deaths.

CV outcomes according to folate tertiles:

  1. Folate levels less than 4.3 ng/mL (n = 239);  (reference group)  
  2. Folate levels 4.3 ng/mL to 8.2 ng/mL (n = 234); 48% lower cardiovascular mortality risk (HR 0.52; 95% CI, 0.30-0.92)
  3. Folate levels greater than 8.2 ng/mL (n = 210); 56% lower cardiovascular mortality risk (HR 0.44; 95% CI, 0.26-0.75)

Patients in tertile 2 had lower all-cause mortality risk (hazard ratio [HR], 0.63; 95% CI, 0.47-0.85).

The risk of CV mortality was lower among patients in tertile 2 compared with those in tertile 1 (P for trend = .01).

It appears that maintaining a serum folate level of at least 4.3 ng/mL was necessary to lower CV mortality risk in this cohort of RA patients. 

The author has no conflicts of interest to disclose related to this subject

Rheumatologists’ Comments

Steven Vlad

| Mar 02, 2020 5:41 pm

Association is not causation! We already went through this with CV disease in general. Supplementing folate did not help!

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