ABSTRACT Our study aims to evaluate the associations between the serum cobalamin (vitamin B12) and related biomarkers with mortality in hypertensive adults. Data on serum cobalamin from the

National Health and Nutrition Examination Survey (NHANES) 1999–2006 and 2011–2014 were included. Mortality status was linked to National Death Index mortality data through 31 December, 2019.

Cox regression and restricted cubic spline (RCS) analyses were used to determine the hazard ratios (HRs) and 95% CIs for mortality risk. A total of 9934 hypertensive adults were included in

the analysis (mean age, 58.1 ± 17.5 years; 4899 [49.3%] men). At 11.0 years of mean follow-up, 935 cardiovascular deaths and 3096 all-cause deaths were identified. Compared to the third

associations of serum cobalamin with cardiovascular and all-cause mortality were 649.9 pg/mL and 577.2 pg/mL, respectively. In addition, compared with the second quartile of circulating

methylmalonic acid (MMA, a cobalamin-deficiency marker), this association with the fourth quartile was evident for an increased rate of cardiovascular and all-cause mortality, with 111% (HR 

= 2.11, 1.71–2.61) and 73% (HR = 1.73, 1.55–1.93) increase. Findings suggest that both lower and higher serum cobalamin concentrations were associated with a higher risk of cardiovascular

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HEALTH STUDY Article Open access 19 November 2024 GERIATRIC NUTRITIONAL RISK INDEX IS ASSOCIATED WITH ADVERSE OUTCOMES IN PATIENTS WITH HYPERTENSION: THE FUKUSHIMA COHORT STUDY Article 20

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ACKNOWLEDGEMENTS We appreciate the people who contributed to the NHANES data we studied. FUNDING This work was supported by General Program of National Natural Science Foundation of China

(81970339 to XL, 82270394 to HZ, 82200425 to RG), and The National High Technology Research and Development Program of China (2017YFC1700505 to XL). AUTHOR INFORMATION Author notes * These

authors contributed equally: Xu Zhu, Yuan Tang AUTHORS AND AFFILIATIONS * Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital,

Nanjing, 210029, China Xu Zhu, Yuan Tang, Iokfai Cheang, Rongrong Gao, Shengen Liao, Wenming Yao, Yanli Zhou & Xinli Li * Department of Cardiology, The Affiliated Suzhou Hospital of

Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Suzhou, 215002, China Haifeng Zhang Authors * Xu Zhu View author publications You can also search for this author inPubMed

 Google Scholar * Yuan Tang View author publications You can also search for this author inPubMed Google Scholar * Iokfai Cheang View author publications You can also search for this author

inPubMed Google Scholar * Rongrong Gao View author publications You can also search for this author inPubMed Google Scholar * Shengen Liao View author publications You can also search for

this author inPubMed Google Scholar * Wenming Yao View author publications You can also search for this author inPubMed Google Scholar * Yanli Zhou View author publications You can also

search for this author inPubMed Google Scholar * Haifeng Zhang View author publications You can also search for this author inPubMed Google Scholar * Xinli Li View author publications You

can also search for this author inPubMed Google Scholar CONTRIBUTIONS XZ: Conceptualization, Methodology, Software, Formal analysis, Writing-original draft, Visualization. YT:

Conceptualization, Methodology, Supervision. IC: Formal analysis, Data curation. RG: Project administration, Writing-review and editing. SL: Writing-review and editing. WY: Supervision. YZ:

Project administration, Writing-review and editing. HZ: Conceptualization, Methodology, Writing-review and editing, Supervision. XL: Conceptualization, Methodology, Project administration,

Writing-review and editing, Supervision. CORRESPONDING AUTHORS Correspondence to Haifeng Zhang or Xinli Li. ETHICS DECLARATIONS CONFLICT OF INTEREST The authors declare that they have no

conflict of interest. ETHICS STATEMENT All participants provided written informed consent and study procedures were approved by the National Center for Health Statistics Research Ethics

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and applicable law. Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Zhu, X., Tang, Y., Cheang, I. _et al._ Nonlinear associations of serum cobalamin with risk of all-cause and

cardiovascular mortality in hypertensive adults. _Hypertens Res_ 46, 1276–1286 (2023). https://doi.org/10.1038/s41440-023-01218-w Download citation * Received: 11 August 2022 * Revised: 14

December 2022 * Accepted: 30 December 2022 * Published: 20 February 2023 * Issue Date: May 2023 * DOI: https://doi.org/10.1038/s41440-023-01218-w SHARE THIS ARTICLE Anyone you share the

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Nature SharedIt content-sharing initiative KEYWORDS * Hypertension * Cobalamin * All-cause mortality * Cardiovascular mortality * NHANES