Wang Jiajia, Gao Feng, Liu Chunjiang, Wang Feng
Department of Rheumatology, Shaoxing People's Hospital, No. 568 Zhong Xing Road, Shaoxing, 312000, Zhejiang, China.
Department of Orthopedics, Kunshan Hospital of Traditional Chinese Medicine, No. 388 Zuchongzhi Road, Kunshan, Jiangsu, China.
Clin Rheumatol. 2025 Mar;44(3):953-968. doi: 10.1007/s10067-025-07337-8. Epub 2025 Jan 24.
The purpose of this study was to examine the association of folate levels, including red blood cell (RBC) and serum folate with mortality (cardiovascular disease (CVD)-related, all-cause, and cancer-related) in patients with arthritis.
We integrated and analyzed the data from the 1999-2018 National Health and Nutrition Examination Survey to conduct this study. Weighted Cox proportional hazard regression, restricted cubic spline (RCS) model, and subgroup analysis were used to analyze the association of RBC and serum folate levels with all-cause, cancer-related, and CVD-related mortality. Additionally, according to the folate levels quartiles, the differences in survival rate of RBC and serum folate with all-cause, cancer-related, and CVD-related mortality were showed in the Kaplan-Meier survival curves.
Our analysis included 12,332 individuals in total. The RCS showed the U-curve association of RBC and serum folate with CVD-related, all-cause, and cancer-related mortality in patients with arthritis. In addition, patients with arthritis in the highest quartile group of RBC and serum folate had the highest risk of CVD-related and all-cause mortality (all Log-rank P < 0.001).
RBC and serum folate concentrations are associated with U-shaped mortality (all-cause and CVD-related) in patients with arthritis in American, and maintaining an appropriate range of serum folate and RBC folate may promote public health. Key Points • Folate levels have U-shaped association with risk of mortality in patients with arthritis. • The potential mechanisms of folate levels in mortality of patients with arthritis need to be further explored.
本研究旨在探讨叶酸水平，包括红细胞（RBC）叶酸和血清叶酸与关节炎患者死亡率（心血管疾病（CVD）相关、全因死亡率和癌症相关死亡率）之间的关联。
我们整合并分析了1999 - 2018年美国国家健康与营养检查调查的数据来开展本研究。采用加权Cox比例风险回归、受限立方样条（RCS）模型和亚组分析来分析RBC叶酸和血清叶酸水平与全因死亡率、癌症相关死亡率和CVD相关死亡率之间的关联。此外，根据叶酸水平四分位数，在Kaplan-Meier生存曲线中展示了RBC叶酸和血清叶酸水平与全因死亡率、癌症相关死亡率和CVD相关死亡率的生存率差异。
我们的分析共纳入12332名个体。RCS模型显示，RBC叶酸和血清叶酸水平与关节炎患者的CVD相关死亡率、全因死亡率和癌症相关死亡率呈U型关联。此外，RBC叶酸和血清叶酸水平处于最高四分位数组的关节炎患者发生CVD相关死亡率和全因死亡率的风险最高（所有Log-rank P < 0.001）。
在美国，RBC叶酸和血清叶酸浓度与关节炎患者的U型死亡率（全因死亡率和CVD相关死亡率）相关，维持血清叶酸和RBC叶酸在适当范围内可能促进公众健康。要点 • 叶酸水平与关节炎患者的死亡风险呈U型关联。 • 叶酸水平在关节炎患者死亡率中的潜在机制有待进一步探索。
