Rimm E B, Willett W C, Hu F B, Sampson L, Colditz G A, Manson J E, Hennekens C, Stampfer M J
Department of Epidemiology, Harvard School of Public Health, Boston, Mass 02115, USA.
JAMA. 1998 Feb 4;279(5):359-64. doi: 10.1001/jama.279.5.359.
Hyperhomocysteinemia is caused by genetic and lifestyle influences, including low intakes of folate and vitamin B6. However, prospective data relating intake of these vitamins to risk of coronary heart disease (CHD) are not available.
To examine intakes of folate and vitamin B6 in relation to the incidence of nonfatal myocardial infarction (MI) and fatal CHD.
Prospective cohort study.
In 1980, a total of 80082 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 B6.
Nonfatal MI and fatal CHD confirmed by World Health Organization criteria.
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 microg/d vs 158 microg/d) and 0.67 (95% CI, 0.53-0.85) for vitamin B6 (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 B6 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 B6, and after excluding multiple vitamin users, among those with higher dietary intakes of folate and vitamin B6. 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).
These results suggest that intake of folate and vitamin B6 above the current recommended dietary allowance may be important in the primary prevention of CHD among women.
高同型半胱氨酸血症由遗传和生活方式因素引起，包括叶酸和维生素B6摄入不足。然而，关于这些维生素摄入量与冠心病（CHD）风险之间的前瞻性数据尚无可用。
研究叶酸和维生素B6摄入量与非致命性心肌梗死（MI）及致命性CHD发病率之间的关系。
前瞻性队列研究。
1980年，来自护士健康研究的80082名女性，她们既往无心血管疾病、癌症、高胆固醇血症或糖尿病史，完成了一份详细的食物频率问卷，据此得出叶酸和维生素B6的通常摄入量。
根据世界卫生组织标准确诊的非致命性MI和致命性CHD。
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事件。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和饱和、多不饱和及反式脂肪的摄入量后，叶酸摄入量处于最高和最低五分位数之间的CHD相对风险（RR）为0.69（95%置信区间[CI]，0.55 - 0.87）（中位数摄入量分别为696μg/d和158μg/d），维生素B6摄入量处于最高和最低五分位数之间的RR为0.67（95%CI，0.53 - 0.85）（中位数摄入量分别为4.6mg/d和1.1mg/d）。控制相同变量后，叶酸和维生素B6摄入量均处于最高五分位数的女性与相反极端情况相比，RR为0.55（95%CI，0.41 - 0.74）。在经常服用复合维生素（RR = 0.76；95%CI，0.65 - 0.90）的女性中，CHD风险降低，复合维生素是叶酸和维生素B6的主要来源，在排除服用复合维生素的女性后，叶酸和维生素B6膳食摄入量较高的女性中CHD风险也降低。在亚组分析中，与不饮酒者相比，高叶酸饮食与CHD之间的负相关在每天饮用至多1杯酒精饮料（RR = 0.69；95%CI，0.49 - 0.97）或每天饮用超过1杯酒精饮料（RR = 0.27；95%CI，0.13 - 0.58）的女性中最为显著。
这些结果表明，叶酸和维生素B6摄入量高于当前推荐的膳食摄入量，可能对女性CHD的一级预防具有重要意义。
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