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Folic acid supplementation cuts stroke risk in adults with high blood pressure

skull stroke

When we think hypertension (high blood pressure) you might not think stroke risk. However, high blood pressure can damage arteries, which often leads to an increased risk for a stroke. But if you suffer from hypertension, you might not need an expensive drug to lower your risk. A new study that included more than 20,000 adults in China with high blood pressure but without a history of stroke or heart attack, the combined use of the hypertension medication enalapril and folic acid, compared with enalapril alone, significantly reduced the risk of first stroke.

Stroke is the leading cause of death in China and second leading cause of death in the world. Primary prevention (prevention prior to a first episode) is particularly important because about 77 percent of strokes are first events. Uncertainty remains regarding the efficacy of folic acid therapy for primary prevention of stroke because of limited and inconsistent data, according to background information in the article.

Researchers had 20,702 adults with hypertension without history of stroke or heart attack randomly assigned to receive daily treatment with a single-pill combination containing enalapril (10 mg) and folic acid (0.8 mg; n = 10,348), or a tablet containing enalapril alone (10 mg; n = 10,354). In conjunction, participants were tested for variations in the MTHFR C677T gene (CC, CT, and TT genotypes) which may affect folate levels.

During a median treatment duration of 4.5 years, first stroke occurred in 282 participants (2.7 percent) in the enalapril-folic acid group compared with 355 participants (3.4 percent) in the enalapril group, representing an absolute risk reduction of 0.7 percent and a relative risk reduction of 21 percent. Analyses also showed significant reductions among participants in the enalapril-folic acid group in the risk of ischemic stroke (2.2 percent vs 2.8 percent) and composite cardiovascular events (cardiovascular death, heart attack and stroke) (3.1 percent vs 3.9 percent).

There was no significant difference between groups in the risk of hemorrhagic stroke, heart attack, or all-cause death, or in the frequencies of adverse events.

The team notes that this trial, along with data on individual baseline folate levels and MTHFR genotypes, has provided convincing evidence that baseline folate level is an important determinant of efficacy of folic acid therapy in stroke prevention.

“The CSPPT is the first large-scale randomized trial to test the hypothesis using individual measures of baseline folate levels. In this population without folic acid fortification, we observed considerable individual variation in plasma folate levels and clearly showed that the beneficial effect appeared to be more pronounced in participants with lower folate levels.”

“We speculate that even in countries with folic acid fortification and widespread use of folic acid supplements such as in the United States and Canada, there may still be room to further reduce stroke incidence using more targeted folic acid therapy–in particular, among those with the TT genotype and low or moderate folate levels.”

Often proponents of natural medicine, or sometimes referred to as alternative medicine suggest that drug companies force pills on us without looking for a naturally occurring alternative. Ignoring aspirin, antibiotics, or just about any type of pain medication, this is just another example of how researchers don’t just look for a fancy pharmaceutical solution. The truth is much simpler, most alternative medicine remedies, the ones that aren’t used in traditional mainstream “western” medicine, just don’t work. If they did, they wouldn’t be alternative medicine, they would simply be medicine.

Yong Huo, MD, Jianping Li, MD, PhD, Xianhui Qin, PhD, Yining Huang, MD, Xiaobin Wang, MD, ScD, Rebecca F. Gottesman, MD, PhD, Genfu Tang, MD, Binyan Wang, MD, PhD, Dafang Chen, PhD, Mingli He, MD, Jia Fu, MD, Yefeng Cai, MD, Xiuli Shi, MD, Yan Zhang, MD, PhD, Yimin Cui, MD, PhD, Ningling Sun, MD, Xiaoying Li, MD, Xiaoshu Cheng, MD, Jian’an Wang, MD, Xinchun Yang, MD, Tianlun Yang, MD, Chuanshi Xiao, MD, Gang Zhao, MD, Qiang Dong, MD, Dingliang Zhu, MD, Xian Wang, MD, PhD, Junbo Ge, MD, Lianyou Zhao, MD, Dayi Hu, MD, Lisheng Liu, MD, & Fan Fan Hou, MD, PhD (2015). Efficacy of Folic Acid Therapy in Primary Prevention of Stroke Among Adults With Hypertension in China Journal of the American Medical Association : 10.1001/jama.2015.2274

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