Folic Acid and Folate

Folic acid, the man-made version of the B vitamin folate, is well-known for preventing birth defects, which is why you’ll find it in prenatal vitamins. But pregnant women aren’t the only ones who might be dangerously lacking in this important nutrient.

People with autoimmune conditions, including rheumatoid arthritis (RA), are often deficient in folate. Now a new study suggests that RA patients who don’t have enough in their bloodstream might be more apt to die from cardiovascular disease.

The new research, which was published in the journal JAMA Network Open, doesn’t prove that that folic acid supplements could help prevent a serious cardiovascular event like a heart attack or stroke, though older research hints at that possibility (especially for people who are deficient).

In the current study, researchers examined the folate levels of 683 people with RA to see if there was a link to cardiovascular disease-related mortality. They determined that those with the most folate in their blood (more than 8.2 ng/mL) were 56 percent less likely to die from cardiovascular disease compared to those with the lowest levels (4.3 ng/mL).

People who fell in the middle — with levels between 4.3 and 8.2 ng/mL — also fared fairly well; they had a 48 percent lower risk of cardiovascular mortality compared to those in the bottom group. For all groups, researchers adjusted for possible confounders including body mass index, C-reactive protein level, and smoking status.

“To our knowledge, our study was the first to examine the association of serum folate level with [cardiovascular] mortality risk among adults with RA,” the authors wrote. “It is unclear why higher folic acid concentrations would be associated with lower [cardiovascular] mortality risk among patients with RA,” but it might be because folate lowers levels of an inflammatory substance called homocysteine.

The researchers suggested that clinicians measure levels of folate in their patients, adding that “if a causal link is validated in future clinical studies, folate supplementation can be an inexpensive strategy for reducing [cardiovascular] mortality risk in patients with RA.”

In the meantime, it can’t hurt to ask your doctor if taking a folate supplement is a good idea. You’ll also find folate in many foods including peas, lentils, oranges, broccoli and spinach.

Folic acid supplements are typically prescribed to help minimize side effects among arthritis patients taking the disease-modifying drug methotrexate.

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Keep Reading

Folic Acid.

Li Y, et al. Folic Acid Supplementation and the Risk of Cardiovascular Diseases: A Meta‐Analysis of Randomized Controlled Trials. Journal of the American Heart Association. August 2016. doi:

Sonawane K, et al. Association of Serum Folate Levels With Cardiovascular Mortality Among Adults With Rheumatoid Arthritis. JAMA Network Open. February 26, 2020. doi:

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