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Folic Acid Supplementation for Stroke Prevention in Patients With Cardiovascular Disease
Tao Tian1, Kun-Qi Yang1, Jin-Gang Cui1
1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Insights
Folic acid supplementation effectively reduces stroke risk in cardiovascular disease patients. Benefits were greater with significant homocysteine reduction and lower folate doses.
Area of Science:
- Cardiovascular Health
- Nutritional Neuroscience
- Public Health Interventions
Background:
- Efficacy of folic acid supplementation for stroke prevention remains debated.
- Cardiovascular disease (CVD) patients are a key population for stroke risk reduction strategies.
Purpose of the Study:
- To evaluate the effectiveness of folic acid supplementation in preventing stroke among individuals with existing cardiovascular disease.
- To synthesize evidence from randomized clinical trials on folic acid and stroke risk in CVD patients.
Main Methods:
- Systematic literature search of PubMed, EMBASE, and Cochrane Library databases up to October 2016.
- Meta-analysis of 11 randomized clinical trials involving 65,790 participants.
- Fixed-effect model used to calculate relative risks (RRs) and 95% confidence intervals (CIs).
- Stratified analyses conducted to explore potential effect modifiers.
Main Results:
- Folic acid supplementation significantly reduced stroke risk in CVD patients (RR = 0.90; 95% CI: 0.84-0.97).
- Greater benefits observed with ≥25% homocysteine reduction (RR = 0.85), daily folate dose <2mg (RR = 0.78), and in regions with limited grain fortification (RR = 0.87).
Conclusions:
- Folic acid supplementation demonstrates efficacy in preventing stroke in patients with cardiovascular disease.
- The benefits of folic acid supplementation for stroke prevention are influenced by homocysteine levels, dosage, and regional food fortification policies.
Background:
Controversy remains regarding the efficacy of folic acid supplementation in reducing the risk of stroke. This study aimed to evaluate the effect of folic acid supplementation on stroke prevention in patients with cardiovascular disease (CVD).
Materials And Methods:
We searched the PubMed, EMBASE and Cochrane Library databases through October 2016 to identify randomized clinical trials of folic acid supplementation to prevent stroke in patients with CVD. Relative risks (RRs) with 95% CIs were used to examine the association between folic acid supplementation and the risk of stroke with a fixed-effect model. Stratified analyses were performed according to modifiers that may affect the efficacy of folic acid supplementation.
Results:
Eleven studies with a total of 65,790 participants were included. Folic acid supplementation was associated with a significant benefit in reducing the risk of stroke in patients with CVD (RR = 0.90; 95% CI: 0.84-0.97; P = 0.005). In the stratified analysis, greater beneficial effects were observed in participants with a decrease in homocysteine concentrations of 25% or greater (RR = 0.85; 95% CI: 0.74-0.97; P = 0.03), those with a daily folate dose of less than 2mg (RR = 0.78; 95% CI: 0.68-0.89; P = 0.01), and populations in regions with no or partly fortified grain (RR = 0.87; 95% CI: 0.81-0.94; P = 0.04).
Conclusions:
Our meta-analysis demonstrated that folic acid supplementation is effective in stroke prevention in patients with CVD.
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