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American Journal of Clinical Nutrition, Vol. 85, No. 1, 117-123, January 2007
© 2007 American Society for Nutrition

ORIGINAL RESEARCH COMMUNICATION

Plasma B vitamins and their relation to the severity of chronic heart failure1,2,3

Markus Herrmann, Stephanie Müller, Ingrid Kindermann, Laureen Günther, Jochem König, Michael Böhm and Wolfgang Herrmann

1 From the Department of Clinical Chemistry and Laboratory Medicine (MH, SM, LG, and WH), the Department of Internal Medicine III (IK and MB), and the Institute of Medical Biometrics, Epidemiology and Medical Informatics (JK), University Hospital of Saarland, Homburg/Saar, Germany

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.

Key Words: Chronic heart failure • homocysteine • folate • vitamin B-12 • NT-proBNP • ejection fraction • coronary artery disease






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