Effect of smoking and folate levels on the efficacy of folic acid therapy in prevention of stroke in hypertensive men

Ziyi Zhou, Jianping Li, Yaren Yu, Youbao Li, Yan Zhang, Lishun Liu, Yun Song, Min Zhao, Yu Wang, Genfu Tang, Mingli He, Xiping Xu, Yefeng Cai, Qiang Dong, Delu Yin, Xiao Huang, Xiaoshu Cheng, Binyan Wang, Fan Fan Hou, Xiaobin Wang & 2 others Xianhui Qin, Yong Huo

Research output: Contribution to journalArticle

Abstract

Background and Purpose - We aimed to examine whether the efficacy of folic acid therapy in the primary prevention of stroke is jointly affected by smoking status and baseline folate levels in a male population in a post hoc analysis of the CSPPT (China Stroke Primary Prevention Trial). Methods - Eligible participants of the CSPPT were randomly assigned to a double-blind daily treatment of a combined enalapril 10-mg and folic acid 0.8-mg tablet or an enalapril 10-mg tablet alone. In total, 8384 male participants of the CSPPT were included in the current analyses. The primary outcome was first stroke. Results - The median treatment duration was 4.5 years. In the enalapril-alone group, the first stroke risk varied by baseline folate levels and smoking status (never versus ever). Specifically, there was an inverse association between folate levels and first stroke in never smokers (P for linear trend=0.043). However, no such association was found in ever smokers. A test for interaction between baseline folate levels and smoking status on first stroke was significant (P=0.045). In the total sample, folic acid therapy significantly reduced the risk of first stroke in never smokers with folate deficiency (hazard risk, 0.36; 95% confidence interval, 0.16-0.83) and in ever smokers with normal folate levels (hazard risk, 0.69; 95% confidence interval, 0.48-0.99). Conclusions - Baseline folate levels and smoking status can interactively affect the risk of first stroke. Our data suggest that compared with never smokers, ever smokers may require a higher dosage of folic acid to achieve a greater beneficial effect on stroke. Our findings need to be confirmed by future randomized trials.

Original languageEnglish (US)
Pages (from-to)114-120
Number of pages7
JournalStroke
Volume49
Issue number1
DOIs
StatePublished - Jan 1 2018

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Folic Acid
Smoking
Stroke
Primary Prevention
Enalapril
Therapeutics
China
Tablets
Confidence Intervals

Keywords

  • Enalapril
  • Folic acid
  • Men
  • Risk
  • Smoking

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Effect of smoking and folate levels on the efficacy of folic acid therapy in prevention of stroke in hypertensive men. / Zhou, Ziyi; Li, Jianping; Yu, Yaren; Li, Youbao; Zhang, Yan; Liu, Lishun; Song, Yun; Zhao, Min; Wang, Yu; Tang, Genfu; He, Mingli; Xu, Xiping; Cai, Yefeng; Dong, Qiang; Yin, Delu; Huang, Xiao; Cheng, Xiaoshu; Wang, Binyan; Hou, Fan Fan; Wang, Xiaobin; Qin, Xianhui; Huo, Yong.

In: Stroke, Vol. 49, No. 1, 01.01.2018, p. 114-120.

Research output: Contribution to journalArticle

Zhou, Z, Li, J, Yu, Y, Li, Y, Zhang, Y, Liu, L, Song, Y, Zhao, M, Wang, Y, Tang, G, He, M, Xu, X, Cai, Y, Dong, Q, Yin, D, Huang, X, Cheng, X, Wang, B, Hou, FF, Wang, X, Qin, X & Huo, Y 2018, 'Effect of smoking and folate levels on the efficacy of folic acid therapy in prevention of stroke in hypertensive men', Stroke, vol. 49, no. 1, pp. 114-120. https://doi.org/10.1161/STROKEAHA.117.018273
Zhou, Ziyi ; Li, Jianping ; Yu, Yaren ; Li, Youbao ; Zhang, Yan ; Liu, Lishun ; Song, Yun ; Zhao, Min ; Wang, Yu ; Tang, Genfu ; He, Mingli ; Xu, Xiping ; Cai, Yefeng ; Dong, Qiang ; Yin, Delu ; Huang, Xiao ; Cheng, Xiaoshu ; Wang, Binyan ; Hou, Fan Fan ; Wang, Xiaobin ; Qin, Xianhui ; Huo, Yong. / Effect of smoking and folate levels on the efficacy of folic acid therapy in prevention of stroke in hypertensive men. In: Stroke. 2018 ; Vol. 49, No. 1. pp. 114-120.
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abstract = "Background and Purpose - We aimed to examine whether the efficacy of folic acid therapy in the primary prevention of stroke is jointly affected by smoking status and baseline folate levels in a male population in a post hoc analysis of the CSPPT (China Stroke Primary Prevention Trial). Methods - Eligible participants of the CSPPT were randomly assigned to a double-blind daily treatment of a combined enalapril 10-mg and folic acid 0.8-mg tablet or an enalapril 10-mg tablet alone. In total, 8384 male participants of the CSPPT were included in the current analyses. The primary outcome was first stroke. Results - The median treatment duration was 4.5 years. In the enalapril-alone group, the first stroke risk varied by baseline folate levels and smoking status (never versus ever). Specifically, there was an inverse association between folate levels and first stroke in never smokers (P for linear trend=0.043). However, no such association was found in ever smokers. A test for interaction between baseline folate levels and smoking status on first stroke was significant (P=0.045). In the total sample, folic acid therapy significantly reduced the risk of first stroke in never smokers with folate deficiency (hazard risk, 0.36; 95{\%} confidence interval, 0.16-0.83) and in ever smokers with normal folate levels (hazard risk, 0.69; 95{\%} confidence interval, 0.48-0.99). Conclusions - Baseline folate levels and smoking status can interactively affect the risk of first stroke. Our data suggest that compared with never smokers, ever smokers may require a higher dosage of folic acid to achieve a greater beneficial effect on stroke. Our findings need to be confirmed by future randomized trials.",
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T1 - Effect of smoking and folate levels on the efficacy of folic acid therapy in prevention of stroke in hypertensive men

AU - Zhou, Ziyi

AU - Li, Jianping

AU - Yu, Yaren

AU - Li, Youbao

AU - Zhang, Yan

AU - Liu, Lishun

AU - Song, Yun

AU - Zhao, Min

AU - Wang, Yu

AU - Tang, Genfu

AU - He, Mingli

AU - Xu, Xiping

AU - Cai, Yefeng

AU - Dong, Qiang

AU - Yin, Delu

AU - Huang, Xiao

AU - Cheng, Xiaoshu

AU - Wang, Binyan

AU - Hou, Fan Fan

AU - Wang, Xiaobin

AU - Qin, Xianhui

AU - Huo, Yong

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N2 - Background and Purpose - We aimed to examine whether the efficacy of folic acid therapy in the primary prevention of stroke is jointly affected by smoking status and baseline folate levels in a male population in a post hoc analysis of the CSPPT (China Stroke Primary Prevention Trial). Methods - Eligible participants of the CSPPT were randomly assigned to a double-blind daily treatment of a combined enalapril 10-mg and folic acid 0.8-mg tablet or an enalapril 10-mg tablet alone. In total, 8384 male participants of the CSPPT were included in the current analyses. The primary outcome was first stroke. Results - The median treatment duration was 4.5 years. In the enalapril-alone group, the first stroke risk varied by baseline folate levels and smoking status (never versus ever). Specifically, there was an inverse association between folate levels and first stroke in never smokers (P for linear trend=0.043). However, no such association was found in ever smokers. A test for interaction between baseline folate levels and smoking status on first stroke was significant (P=0.045). In the total sample, folic acid therapy significantly reduced the risk of first stroke in never smokers with folate deficiency (hazard risk, 0.36; 95% confidence interval, 0.16-0.83) and in ever smokers with normal folate levels (hazard risk, 0.69; 95% confidence interval, 0.48-0.99). Conclusions - Baseline folate levels and smoking status can interactively affect the risk of first stroke. Our data suggest that compared with never smokers, ever smokers may require a higher dosage of folic acid to achieve a greater beneficial effect on stroke. Our findings need to be confirmed by future randomized trials.

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