Plasma B vitamins and their relation to the severity of chronic heart failure.

Abstract

BACKGROUND:

Total homocysteine (tHcy) has been linked to the severity of chronic heart failure (CHF). Elevated tHcy concentrations are mainly caused by folate and vitamin B-12 deficiencies.

OBJECTIVE:

We hypothesized that folate and vitamin B-12 deficiencies can explain the relation between tHcy and the severity of CHF.

DESIGN:

We investigated 987 CHF patients. All subjects underwent a physical examination and blood sampling. Cardiac catheterization was performed in 929 patients and echocardiography in 460 patients. Serum tHcy, folate, vitamin B-12, and N-terminal pro-B-type natriuretic-peptide (NT-proBNP) were measured and renal and hepatic function were studied.

RESULTS:

tHcy increased with increasing New York Heart Association (NYHA) classes of heart failure (P < 0.001) and correlated with the left ventricular ejection fraction (EF; r = -0.150, P < 0.001). Contrary to the hypothesis, vitamin B-12 (P < 0.001) increased with NYHA class (P < 0.001) and was negatively correlated with EF (r = -0.080, P = 0.015). Folate showed no relation with NYHA class or EF. Comparable results were obtained for NT-proBNP (tHcy: r = 0.27, P < 0.001; vitamin B-12: r = 0.091, P = 0.004; folate: r = -0.045, P = 0.169). The correlations between tHcy, EF, and NT-proBNP were significantly stronger in patients without coronary artery disease (CAD) than in those with CAD. Regression analysis showed that tHcy, but not B vitamins, is a strong predictor of EF and NT-proBNP.

CONCLUSIONS:

This study showed that tHcy, but not folate and vitamin B-12, is related to clinical, echocardiographic, and laboratory variables of CHF, which indicates a relation between tHcy and the severity of CHF. This relation is stronger in patients without CAD. The lack of association of folate and the paradoxical relation of vitamin B-12 with CHF can possibly be explained by a disturbance in hepatic homeostasis.

• Authors: Markus Herrmann, Stephanie Müller, Ingrid Kindermann, Laureen Günther, Jochem König, Michael Böhm, Wolfgang Herrmann
• Journal: The American journal of clinical nutrition (Am J Clin Nutr) Vol. 85 Issue 1 Pg. 117-23 (Jan 2007) ISSN: 0002-9165 [Print] United States
• PMID: 17209186 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Homocysteine
• Vitamin B Complex
• Folic Acid
• Vitamin B 12

Topics

• Aged
• Cardiac Catheterization
• Echocardiography
• Female
• Folic Acid (blood)
• Folic Acid Deficiency (blood, complications)
• Heart Failure (blood, etiology, pathology)
• Homocysteine (blood)
• Humans
• Liver (metabolism)
• Male
• Middle Aged
• Multivariate Analysis
• Severity of Illness Index
• Vitamin B 12 (blood)
• Vitamin B 12 Deficiency (blood, complications)
• Vitamin B Complex (blood)