Article Text

Download PDFPDF
Original article
Vitamin B12 and folate deficiency in chronic heart failure
  1. Haye H van der Wal1,
  2. Josep Comin-Colet2,
  3. Ijsbrand T Klip1,
  4. Cristina Enjuanes2,
  5. Niels Grote Beverborg1,
  6. Adriaan A Voors1,
  7. Waldemar Banasiak3,
  8. Dirk J van Veldhuisen1,
  9. Jordi Bruguera2,
  10. Piotr Ponikowski3,4,
  11. Ewa A Jankowska3,4,
  12. Peter van der Meer1
  1. 1Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  2. 2Heart Failure Program, Hospital del Mar and Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
  3. 3Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
  4. 4Cardiology Department, Military Hospital, Wroclaw, Poland
  1. Correspondence to Dr Peter van der Meer, Department of Cardiology, Thorax Center, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, Groningen 9700 RB, The Netherlands; p.van.der.meer{at}


Objective To determine the prevalence, clinical correlates and the effects on outcome of vitamin B12 and folic acid levels in patients with chronic heart failure (HF).

Methods We studied an international pooled cohort comprising 610 patients with chronic HF. The main outcome measure was all-cause mortality.

Results Mean age of the patients was 68±12 years and median serum N-terminal prohormone brain natriuretic peptide level was 1801 pg/mL (IQR 705–4335). Thirteen per cent of the patients had an LVEF >45%. Vitamin B12 deficiency (serum level <200 pg/mL), folate deficiency (serum level <4.0 ng/mL) and iron deficiency (serum ferritin level <100 µg/L, or 100–299 µg/L with a transferrin saturation <20%) were present in 5%, 4% and 58% of the patients, respectively. No significant correlation between mean corpuscular volume and vitamin B12, folic acid or ferritin levels was observed. Lower folate levels were associated with an impaired health-related quality of life (p=0.029). During a median follow-up of 2.10 years (1.31–3.60 years), 254 subjects died. In multivariable proportional hazard models, vitamin B12 and folic acid levels were not associated with prognosis.

Conclusions Vitamin B12 and folate deficiency are relatively rare in patients with chronic HF. Since no significant association was observed between mean corpuscular volume and neither vitamin B12 nor folic acid levels, this cellular index should be used with caution in the differential diagnosis of anaemia in patients with chronic HF. In contrast to iron deficiency, vitamin B12 and folic acid levels were not related to prognosis.


Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.