Association of Vitamin B12 and Folate Deficiency with Vasovagal Syncope: A Case-Control Study

Arya  Aminorroaya; Ali  Vasheghani-Farahani; Hamed  Tavolinejad; Zahra  Aryan; Somayeh  Yadangi; Ali  Bozorgi; Saeed  Sadeghian; Mohammadali  Boroumand; Masud  Yunesian; Masih  Tajdini

doi:10.18502/jthc.v21i1.21279

Arya Aminorroaya Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
Ali Vasheghani-Farahani Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Hamed Tavolinejad Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Zahra Aryan Department of Medicine, Rutgers New Jerse y Medical School, Newark, NJ, USA.
Somayeh Yadangi Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Ali Bozorgi Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Saeed Sadeghian Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Mohammadali Boroumand Department of Pathology and Laboratory Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Masud Yunesian School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Masih Tajdini Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jthc.v21i1.21279

Keywords: Syncope; Vasovagal; Folic Acid; Folic Acid Deficiency; Vitamin B12; Vitamin B12 Deficiency; Homocysteine

Abstract

Background: Clinical evidence suggests an association between vitamin B12 deficiency and vasovagal syncope (VVS) in pediatric patients. This study investigated the association of vitamin B12 and folate deficiency with VVS in adults.

Methods: In this case-control study, adult patients with VVS who presented to the tertiary syncope unit for head-up tilt table testing comprised the case group. Age- and sex-matched individuals without syncope history from the population-based Tehran Cohort Study served as the control group. Exclusion criteria included but were not limited to the use of vitamin B supplements, carbamazepine, or phenobarbital, and sleeve gastrectomy. Serum vitamin B12, folate, and homocysteine levels were measured and compared.

Results: From February 2020 through February 2021, 44 patients comprised the case group, matched with 44 controls (mean age, 37.9 years; 23 [52.3%] females in each group). No statistically significant difference existed between the groups in vitamin B12 or folate deficiency or serum levels. Serum vitamin B12 levels were significantly lower in patients with frequent VVS (≥3 lifetime episodes) than in patients with infrequent VVS (<3 lifetime episodes) (233.8 [80.7] vs 305.2 [118.1] pg/mL; P=0.042), and the association remained significant after adjustment for confounders (P=0.026).

Conclusion: No association existed between vitamin B12 or folate deficiency or serum levels and VVS. Frequent VVS was associated with lower serum vitamin B12 levels than infrequent VVS.