Document Detail

Effect of folic acid fortification of food on homocysteine-related mortality.
MedLine Citation:
PMID:  14749159     Owner:  NLM     Status:  MEDLINE    
PURPOSE: In 1998, the Food and Drug Administration mandated the fortification of food products with folic acid. The effect of this rule on mortality associated with homocysteine levels in patients with coronary artery disease is unknown. METHODS:We studied 2481 consecutive patients with coronary artery disease who underwent coronary angiography between 1994 and 1999, and who had baseline homocysteine measurements and at least 2 years of follow-up. Patients were divided into prefortification (1994 to 1997, n = 1595) and postfortification (1998 to 1999, n = 886) groups, as well as classified based on baseline homocysteine levels (normal to low, intermediate, and high). Homocysteine levels were measured by fluorescence polarization immunoassay. Mortality was determined by telephone survey or from a national Social Security database or hospital records. RESULTS: After implementation of the fortification rule, median homocysteine levels declined from 13.8 to 12.3 micromol/L (P <0.001), and the proportion of patients with high homocysteine levels (>15 micromol/L) decreased from 41% (n = 650) to 28% (n = 249) (P <0.001). Overall, homocysteine was a modest risk factor for mortality (adjusted relative risk [RR] = 1.03 per micromol/L; 95% confidence interval [CI]: 1.01 to 1.05; P = 0.006). There was no significant interaction between fortification status and homocysteine category with mortality (P for interaction = 0.85). Two-year mortality was reduced minimally (7.8% [n = 124] to 7.2% [n = 64]; RR = 0.93; 95% CI: 0.68 to 1.27; P = 0.63; adjusted RR = 0.97; 95% CI: 0.68 to 1.40), but was consistent with the expectation of a modest reduction in homocysteine levels. CONCLUSION: Homocysteine is an independent, graded risk factor for mortality. Homocysteine levels decreased modestly after the fortification of food with folic acid, but the effects on mortality were minor and likely attributable to other factors, indicating the need for more aggressive measures to reduce homocysteine-associated cardiovascular risk.
Jeffrey L Anderson; Kurt R Jensen; John F Carlquist; Tami L Bair; Benjamin D Horne; Joseph B Muhlestein
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of medicine     Volume:  116     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-01-29     Completed Date:  2004-02-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  158-64     Citation Subset:  AIM; IM    
Cardiovascular Department, LDS Hospital, and University of Utah, Salt Lake City, Utah 84143, USA.
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MeSH Terms
Coronary Disease / blood,  mortality*
Folic Acid / administration & dosage*
Food, Fortified*
Homocysteine / blood*
Risk Factors
Reg. No./Substance:
454-28-4/Homocysteine; 59-30-3/Folic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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