(Stroke. 1995;26:1166-1170.)
© 1995 American Heart Association, Inc.
Articles |
Serum Folate and Risk for Ischemic Stroke
First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study
From the Cardiovascular Health Studies Branch, Division of Chronic Disease Control and Community Intervention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (W.H.G., R.F.A., J.B.C., M.L.C.); and the Department of Epidemiology and Preventive Medicine, the Department of Neurology, and the Stroke Epidemiology Unit, University of Maryland School of Medicine, Baltimore (S.J.K.).
Background and Purpose A serum folate concentration 
9.2
nmol/L has been associated with elevated levels of plasma
homocyst(e)ine. Elevated homocyst(e)ine levels have been associated
with ischemic stroke in case-control studies; however, the
results from prospective studies have been equivocal. We investigated
whether a folate concentration 9.2 nmol/L was associated with
ischemic stroke in a national cohort.
Methods We used data from the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (n=2006). Cox proportional hazards analyses were used to adjust for differences in follow-up time and covariates. During the 13-year follow-up, 98 ischemic strokes occurred.
Results After adjusting for age, race, sex, education, diabetes,
history of heart disease, systolic blood pressure, body mass index,
hemoglobin level, cigarette smoking, and alcohol intake, participants
with a folate concentration 9.2 nmol/L were at slightly increased
risk for ischemic stroke (relative risk [RR], 1.37; 95%
confidence interval [CI], 0.82 to 2.29). There was a folate-race
interaction (P=.11 for interaction term). Whites with a
folate concentration 9.2 nmol/L had a relative risk of 1.18 (95% CI,
0.67 to 2.08), whereas blacks had a relative risk of 3.60 (95% CI,
1.02 to 12.71).
Conclusions These findings suggest that a folate concentration
9.2 nmol/L may be a risk factor for ischemic stroke,
especially in blacks. However, given the small number of stroke events,
additional studies are needed to assess the role of folate in the
epidemiology of ischemic stroke.
Key Words: epidemiology • folic acid • racial differences • risk factors
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