Effect of folic acid supplementation on cancer risk among adults with hypertension in China: A randomized clinical trial

Xianhui Qin, Lin Shen, Rong Zhang, Youbao Li, Xiaobin Wang, Binyan Wang, Xiaodong Jiang, Hua Jiang, Yu Lei, Fan Fan Hou, Jin Gu, Yong Huo

Research output: Contribution to journalArticle

Abstract

The relationship of folic acid supplementation with the risk of cancer remains inconclusive. We aimed to evaluate the effects of folic acid supplementation on cancer incidence among adults with hypertension without history of stroke or myocardial infarction (MI) in the China Stroke Primary Prevention Trial (CSPPT). A total of 20,702 hypertensive adults without history of stroke or MI, stratified by MTHFR C677T genotypes(CC, CT and TT), were randomly assigned to receive double-blind daily treatment with a single pill containing 10 mg enalapril and 0.8 mg folic acid(n = 10,348) or a pill containing 10 mg enalapril alone(n = 10,354). During a median treatment duration of 4.5 years, cancer occurred in 116 participants(1.12%) in the enalapril-folic acid group versus 116 participants(1.12%) in the enalapril group (HR, 1.00; 95%CI, 0.77–1.29). There was also no significant difference in the HRs for specific types of cancer(esophageal, gastric, breast, lung, colorectal, head and neck, liver and gynecologic cancer or lymphoma) or cancer mortality(HR, 1.05; 95%CI, 0.69–1.58). For participants not receiving folic acid treatment (enalapril only group), MTHFR 677 TT genotype was an independent predictor of total cancer risk compared to CC genotype (HR, 1.86; 95%CI, 1.07–3.22). Consistently, a beneficial effect was observed in participants with MTHFR TT genotype and low folate levels (<9.0 ng/mL; HR, 0.47; 95%CI, 0.24–0.94). There is no evidence that 0.8 mg daily folic acid supplementation can increase the risk of cancer incidence among adults with hypertension without history of stroke or MI in China. Our data suggest a protective effect in participants with MTHFR TT genotype and low folate levels.

Original languageEnglish (US)
Pages (from-to)837-847
Number of pages11
JournalInternational Journal of Cancer
Volume141
Issue number4
DOIs
StatePublished - Aug 15 2017

Keywords

  • MTHFR C677T genotypes
  • baseline folate levels
  • cancer incidence
  • folic acid supplementation

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint Dive into the research topics of 'Effect of folic acid supplementation on cancer risk among adults with hypertension in China: A randomized clinical trial'. Together they form a unique fingerprint.

  • Cite this

    Qin, X., Shen, L., Zhang, R., Li, Y., Wang, X., Wang, B., Jiang, X., Jiang, H., Lei, Y., Hou, F. F., Gu, J., & Huo, Y. (2017). Effect of folic acid supplementation on cancer risk among adults with hypertension in China: A randomized clinical trial. International Journal of Cancer, 141(4), 837-847. https://doi.org/10.1002/ijc.30094