Is vitamin B12 deficiency a risk factor for cardiovascular disease in vegetarians?

Am J Prev Med. 2015 Jun;48(6):e11-26. doi: 10.1016/j.amepre.2015.02.009.


The goal of this paper is to describe the role of vitamin B12 deficiency in cardiovascular disease development among vegetarians. Vegetarians have a high prevalence of vitamin B12 deficiency. Deficiency of this vitamin is associated with a variety of atherogenic processes that are mainly, but not exclusively, due to vitamin B12 deficiency-induced hyperhomocysteinemia. Each 5-μmol/L increase above 10 μmol/L of serum homocysteine is associated with a 20% increased risk of circulatory health problems. Mean homocysteine concentration >10 μmol/L among vegetarians was reported in 32 of 34 reports. Macrocytosis associated with vitamin B12 deficiency is also associated with fatal and non-fatal coronary disease, myocardial infarction, stroke, and other circulatory health problems. Compared with non-vegetarians, vegetarians have an improved profile of the traditional cardiovascular disease risk factors, including serum lipids, blood pressure, serum glucose concentration, and weight status. However, not all studies that assessed cardiovascular disease incidence among vegetarians reported a protective effect. Among studies that did show a lower prevalence of circulatory health problems, the effect was not as pronounced as expected, which may be a result of poor vitamin B12 status due to a vegetarian diet. Vitamin B12 deficiency may negate the cardiovascular disease prevention benefits of vegetarian diets. In order to further reduce the risk of cardiovascular disease, vegetarians should be advised to use vitamin B12 supplements.

Publication types

  • Review

MeSH terms

  • Cardiovascular Diseases / etiology*
  • Diet, Vegetarian / adverse effects*
  • Dietary Supplements
  • Homocysteine / blood
  • Humans
  • Hyperhomocysteinemia / complications*
  • Hyperhomocysteinemia / epidemiology
  • Prevalence
  • Risk Factors
  • Vegetarians
  • Vitamin B 12 Deficiency / complications*


  • Homocysteine