Published Online
on December 11, 2003

A more recent version of this article appeared on January 1, 2004

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Submitted on August 12, 2003
Accepted on September 17, 2003

Folate, Vitamin B₆, and B₁₂ Intakes in Relation to Risk of Stroke Among Men

Ka He MD^*; Anwar Merchant DMD; Eric B. Rimm ScD; Bernard A. Rosner PhD; Meir J. Stampfer MD; Walter C. Willett MD; and Alberto Ascherio MD

From the Departments of Nutrition (K.H., A.M., E.B.R., M.J.S., W.C.W., A.A.), Epidemiology (E.B.R., M.J.S., W.C.W., A.A.), and Biostatistics (B.A.R.), Harvard School of Public Health, Boston, Mass; Channing Laboratory (E.B.R., B.A.R., M.J.S., W.C.W., A.A.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; and Department of Preventive Medicine (K.H.), Northwestern University Feinberg School of Medicine, Chicago, Ill.

^* To whom correspondence should be addressed. E-mail: kahe{at}northwestern.edu.

Background and Purpose--Folate, vitamin B₆, and B₁₂ deficiency are related to elevated blood homocysteine level. However, the effects of intakes of these vitamins on risk of stroke are still uncertain. This study examines intakes of folate, vitamin B₆, and B₁₂ in relation to risk of ischemic and hemorrhagic stroke.

Methods--We enrolled 43 732 men, aged 40 to 75 years, who were free of cardiovascular diseases and diabetes at baseline. Participants were followed from 1986 to 2000. Dietary information was assessed every 4 years using a detailed and validated semiquantitative food frequency questionnaire. The main outcome measures were incident ischemic and hemorrhagic strokes.

Results--A total of 725 incident strokes, including 455 ischemic, 125 hemorrhagic, and 145 unknown types of stroke, were documented during the 14-year follow-up. After adjustment for major lifestyle and dietary factors, intake of folate was associated with a significantly lower risk of ischemic but not hemorrhagic stroke. The multivariate relative risk of ischemic stroke was 0.71 (95% CI, 0.52 to 0.96; P for trend=0.05) for men in the highest quintile of intake compared with those who in the lowest quintile. Intake of vitamin B₁₂, but not B₆, was also inversely associated with risk of ischemic stroke.

Conclusions--Our findings suggest that increased folate intake is associated with decreased risk of ischemic stroke in men.

Key words: cerebrovascular accident • folic acid • vitamin B₆ • vitamin B₁₂

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