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A study published in the Journal of the American Medical Association has reported on the effect of folate supplementation on risk of stroke in adults with hypertension.

Researchers set out to assess the role of folate supplementation in stroke risk, since there have been some conflicting results in the literature regarding its potential to have a protective effect. The study included participants from the China Stroke Primary Prevention Trial, who were recruited from 32 communities within the Jiangsu and Anhui provinces in China. The study population was made up of men and women aged between 45 and 75 years, with no history of stroke or myocardial infarction. A total of 20 702 participants were included in the study. The participants also underwent genetic testing for the MTHFR gene, which encodes for the enzyme that regulates folate metabolism. Alterations to the MTHFR gene results in a reduction in the activity of the enzyme, ultimately resulting in a reduction in folate levels. This gene alteration may play a role in the protective effect of folate on stroke risk.

The participants were assigned to treatment groups of either 10mg enalapril daily (standard antihypertensive drug), or 10mg enalapril plus 0.8mg of folic acid daily. While serum folate levels were not significantly different between treatment groups at the initiation of the study, there was a significant increase in serum folate observed in the enalapril plus folate treatment group (11.2ng/mL) compared with the enalapril alone treatment group (4.4ng/mL). There was no difference in serum folate levels between the different MTHFR genes. Patients in the enalapril plus folic acid group had a significant reduction in relative risk of first stroke compared to the enalapril alone treatment group. However, there were no differences noted in adverse events between treatment groups.

Overall the results of the study demonstrated that this group of adults with hypertension, who did not have a history of stroke or myocardial infarction, had a reduction in relative risk of first-time stroke by 21% when taking a combination of enalapril and folic acid. The authors state that primary prevention of stroke is highly important, since approximately 77% of strokes are first-time events.



Huo, Y, Li, J, Qin, X, Huang, Y, Wang, X, Gottesman, RF, Tang, G, Wang, B, Chen, D, He, M, Fu, J, Cai, Y, Shi, X, Zhang, Y, Cui, Y, Sun, N, Li, X, Cheng, X, Wang, J, Yang, X, Yang, T, Xiao, C, Zhao, G, Dong, Q, Zhu, D, Wang, X, Ge, J, Zhao, L, Hu, D, Liu, L, Hou, FF; for the CSPPT Investigators “Efficacy of Folic Acid Therapy in Primary Prevention of Stroke Among Adults With Hypertension in China:  The CSPPT Randomized Clinical Trial” Journal of the American Medical Association, April 7, 2015, Vol 313, No. 13

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Written by Deborah Tallarigo, PhD


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