Cardiac Failure and Folate Deficiency

SIR,-Your interesting leading article on cardiac failure and folate deficiency (24 January, p. 188) commented on the possible causes of this association, and factors like impaired dietary intake and gastrointestinal malabsorption were mentioned. A contributory cause could well be excessive folate loss in the urine. Urinary folate excretion has been poorly studied, but we recently reported an unexpected increase of urinary folate in association with congestive cardiac failure.' As much as 61 6,tg. folate was lost per day, while normal controls excreted 0-1-18-0,ug. folate per day. Urinary folate loss is unlikely to be the sole cause of folate deficiency in these patients, but could well be an important contributory factor in a patient with prolonged anorexia. One could speculate that excessive urinary folate results from abnormal folate liberation secondary to the liver damage of chronic congestive failure. Urinary folate excretion is increased in cirrhosis and acute hepatitis' and also after surgical trauma.2-I am, etc., F. P. RETIEF.