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Nutritional Epidemiology

Plasma Homocysteine, but Not Folate or Vitamin B-12, Predicts Mortality in Older People in the United Kingdom^1,2

³ Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; ⁴ Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK; ⁵ Clinical Trial Service Unit, Nuffield Department of Clinical Medicine, Oxford OX3 7LF, UK; and ⁶ Institute of Human Nutrition, University of Southampton Medical School, Southampton SO16 6YD, UK

^* To whom correspondence should be addressed. E-mail: alan.dangour{at}lshtm.ac.uk.

There is uncertainty about the importance of plasma levels of homocysteine, vitamin B-12, and folate for all-cause and cardiovascular disease (CVD) mortality in older people. We examined the associations between plasma levels of folate, vitamin B-12, and homocysteine, and all-cause and CVD mortality among community-dwelling adults aged 75 y living in the United Kingdom. In a population-based prospective cohort study, 853 men and women aged 75 y were examined in 1995–98 as part of the Medical Research Council Trial of Assessment and Management of Older People in the Community. During a median follow-up of 7.6 y (5528 person-years of follow-up), 429 individuals (50.3%) died, including 185 from CVD. Individuals with plasma homocysteine levels in the top one-third compared with the bottom one-third had a 2-fold higher risk of all-cause mortality (hazard ratio, 2.20; 95% CI, 1.76, 2.75; P < 0.001) and CVD mortality (hazard ratio, 1.96; 95% CI, 1.39, 2.78; P < 0.001) after adjustment for age, sex, and other covariates. There was no association of plasma folate or vitamin B-12 levels with mortality. Our results extend previously reported associations of homocysteine with mortality, and the absence of associations of folate and vitamin B-12 with mortality, to the older population.