Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart disease among women
Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart disease among women
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DOI：
10.1001/jama.279.5.359
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发表时间：
1998-02-04
影响因子：
120.7
通讯作者：
Stampfer, MJ
中科院分区：
文献类型：
--
作者：
Rimm, EB;Willett, WC;Stampfer, MJ
背景：高同型半胱氨酸血症是由遗传和生活方式影响引起的，包括叶酸和维生素 B-6 摄入量低。然而，目前还没有这些维生素摄入量与冠心病 (CHD) 风险相关的前瞻性数据。目的。-检查叶酸和维生素 B-6 的摄入量与非致命性心肌梗塞 (MI) 和致命性 CHD 发生率的关系。设计。-前瞻性队列研究。环境和患者。-1980 年，护士健康研究中总共有 80 082 名女性，她们以前没有心血管疾病、癌症、高胆固醇血症或糖尿病患者完成了一份详细的食物频率调查问卷，从中我们得出了叶酸和维生素 B-6 的日常摄入量。主要结果指标。-按世界卫生组织标准确认的非致命性 MI 和致命性 CHD。结果。-在 14 年的随访期间，我们记录了 658 例非致命性 MI 事件和 281 例致命性 CHD 病例。在控制了心血管危险因素（包括吸烟、高血压以及酒精、纤维、维生素 E、饱和脂肪、多不饱和脂肪和反式脂肪的摄入量）后，极端五分位数之间的冠心病相对风险 (RR) 为叶酸（中位摄入量，696 微克/天 vs 158 微克/天）的 0.69（95% 置信区间 [CI]，0.55-0.87）和 0.67（95% CI， 0.53-0.85）维生素 B-6（中位摄入量，4.6 毫克/天 vs 1.1 毫克/天）。控制相同的变量后，叶酸和维生素 B-6 摄入量最高五分位数的女性与相反极端的女性相比，RR 为 0.55（95% CI，0.41-0.74）。经常使用多种维生素（叶酸和维生素 B-6 的主要来源）的女性（RR=0.76；95% CI，0.65-0.90）以及排除多种维生素使用者后，饮食中叶酸和维生素 B-6 摄入量较高的女性，患冠心病的风险降低。在亚组分析中，与不饮酒者相比，每天饮用多达 1 杯酒精饮料（RR=0.69；95% CI，0.49-0.97）或每天饮酒超过 1 杯（RR=0.27；95% CI，0.13-0.58）的女性中，高叶酸饮食与冠心病之间的负相关性最强。结论。-这些结果表明，叶酸和维生素的摄入量高于当前推荐膳食摄入量的 B-6 对于女性冠心病的一级预防可能很重要。
Context.-Hyperhomocysteinemia is caused by genetic and lifestyle influences, including low intakes of folate and vitamin B-6. However, prospective data relating intake of these vitamins to risk of coronary heart disease (CHD) are not available,Objective.-To examine intakes of folate and vitamin B-6 in relation to the incidence of nonfatal myocardial infarction (MI) and fatal CHD.Design.-Prospective cohort study.Setting and Patients.-In 1980, a total of 80 082 women from the Nurses' Health Study with no previous history of cardiovascular disease, cancer, hypercholesterolemia, or diabetes completed a detailed food frequency questionnaire from which we derived usual intake of folate and vitamin B-6.Main Outcome Measure.-Nonfatal MI and fatal CHD confirmed by World Health Organization criteria.Results.-During 14 years of follow-up, we documented 658 incident cases of nonfatal MI and 281 cases of fatal CHD. After controlling for cardiovascular risk factors, including smoking and hypertension and intake of alcohol, fiber, vitamin E, and saturated, polyunsaturated, and trans fat, the relative risks (RRs) of CHD between extreme quintiles were 0.69 (95% confidence interval [CI], 0.55-0.87) for folate (median intake, 696 mu g/d vs 158 mu g/d) and 0.67 (95% CI, 0.53-0.85) for vitamin B-6 (median intake, 4.6 mg/d vs 1.1 mg/d). Controlling for the same variables, the RR was 0.55 (95% CI, 0.41-0.74) among women in the highest quintile of both folate and vitamin B-6 intake compared with the opposite extreme. Risk of CHD was reduced among women who regularly used multiple vitamins (RR=0.76; 95% CI, 0.65-0.90), the major source of folate and vitamin B-6, and after excluding multiple vitamin users, among those with higher dietary intakes of folate and vitamin B-6. In a subgroup analysis, compared with nondrinkers, the inverse association between a high-folate diet and CHD was strongest among women who consumed up to 1 alcoholic beverage per day (RR=0.69; 95% CI, 0.49-0.97) or more than 1 drink per day (RR=0.27; 95% CI, 0.13-0.58).Conclusion.-These results suggest that intake of folate and vitamin B-6 above the current recommended dietary allowance may be important in the primary prevention of CHD among women.