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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. 

Disclosures
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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