Can Folic Acid (Vitamin B9) Lowers Stroke Risk in People with High Blood Pressure?

Can Folic Acid (Vitamin B9) Lowers Stroke Risk in People with High Blood Pressure?

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Title: Efficacy of Folic Acid Therapy in Primary Prevention of Stroke Among Adults With Hypertension in China

Author: Huo et al

Journal: JAMA

Objective: To test the primary hypothesis that therapy with enalapril and folic acid is more effective in reducing first stroke than enalapril alone among Chinese adults with hypertension.

Background

Folic Acid Supplement Options: http://amzn.to/2pW4Inh

Health Benefits of Folic Acid (Folate, Vitamin B9): https://youtu.be/1GI7Onlwfao

Folic acid is a well known vitamin, found in a variety of foods and most well known as a supplement taken by pregnant women. It has some well established benefits and some less well established benefits, this includes:

  • Prevention of birth defects during pregnancy
  • Weak evidence that it reduces risk of coronary artery disease, heart attack and stroke
  • Weak evidence for preventing dementia and alzheimers disease
  • Age related hearing loss
  • Depression
  • Cancer, namely colon, breast, cervical, pancreatic, and stomach.

Common dietary sources include:

  • Greens ( spinach, dark leafy greens, asparagus, brussel sprouts)
  • Beans (Lima beans, soybeans, kidney beans, white beans, mung beans)
  • Citrus fruits
  • Whole grains and all grain and cereal products in the U.S. are fortified with it
  • Many others

Methods

The authors used the data from the China Stroke Primary Prevention Trial, a randomized, double-blind clinical trial which includes 20 702 adults with hypertension without history of stroke or myocardial infarction.

Eligible participants were randomly assigned to treatment either with enalapril (10mg) and folic acid (0.8mg) (n = 10 348) or just enalapril (10mg) alone (n = 10 354).

The primary outcome was first stroke.

Secondary outcomes included first ischemic stroke; first hemorrhagic stroke; MI; a composite of cardiovascular events consisting of cardiovascular death, MI, and stroke; and all-cause death.

Results

Compared with the enalapril alone group, the enalapril–folic acid group had a

  • 21% reduction in first stroke (hazard ratio [HR], 0.79; 95%CI, 0.68-0.93)
  • 24% reduction in first ischemic stroke (HR, 0.76; 95%CI, 0.64-0.91)
  • 20% reduction total cardiovascular events (consisting of cardiovascular death, MI, and stroke)(HR, 0.80; 95%CI, 0.69-0.92).

Compared with the enalapril alone group, the enalapril–folic acid group had no difference in risk of

  • hemorrhagic stroke (HR, 0.93; 95%CI, 0.65-1.34),
  • myocardial infarction (heart attack) (HR, 1.04; 95%CI, 0.60-1.82), and
  • all-cause deaths (HR, 0.94; 95%CI, 0.81-1.10)

Conclusions

In hypertensive chinese adults, the addition of folic acid to enalapril significantly reduced the risk of stroke.

This benefit was most prominent in individuals who had low levels of folate at the beginning of the study.

It is worth noting that some studies have shown no benefit, and that the areas where there is the most benefit are regions of the world that do not fortify food products with folic acid.

Original Article

Huo, Y., Li, J., & Qin, X. (2015). Efficacy of Folic Acid Therapy in Primary Prevention of Stroke Among Adults With Hypertension in China. Jama, 313(13), 1325. doi:10.1001/jama.2015.2274

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