@article{5638354d74664c11bbc3741d106e2eac,
title = "Effect of smoking and folate levels on the efficacy of folic acid therapy in prevention of stroke in hypertensive men",
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.",
keywords = "Enalapril, Folic acid, Men, Risk, Smoking",
author = "Ziyi Zhou and Jianping Li and Yaren Yu and Youbao Li and Yan Zhang and Lishun Liu and Yun Song and Min Zhao and Yu Wang and Genfu Tang and Mingli He and Xiping Xu and Yefeng Cai and Qiang Dong and Delu Yin and Xiao Huang and Xiaoshu Cheng and Binyan Wang and Hou, {Fan Fan} and Xiaobin Wang and Xianhui Qin and Yong Huo",
note = "Funding Information: The study was supported by the Projects of National Natural Science Foundation of China (81473052 and 81402735); the Science and Technology Project of Guangdong Province (2009A030100008 and Funding Information: All authors have completed the ICMJE uniform disclosure form and have declared the following: Dr Qin reports grants from the National Science Foundation and consulting fees from AUSA Research Institute, Shenzhen AUSA. Dr Huo reports grants from the National Major Scientific and Technological Special Project and nonfinancial support from Shenzhen AUSA. Dr Xu reports grants from the Ministry of Science and Technology of the People{\textquoteright}s Republic of China, Department of Development and Reform, Shenzhen Municipal Government, Department of Science and Innovation, Shenzhen Municipal Government, and personal fees from Shenzhen AUSA Pharmed, Co, Ltd. Dr B. Wang reports grants from the National Science Foundation, Department of Science and Innovation, and Shenzhen Municipal Government and consulting fees from AUSA Research Institute, Shenzhen AUSA. Dr He reports grants from the Bureau of Science and Technology of Jiangsu Province, the Government of Jiangsu Province, Jiangsu, China. Dr Hou reports grants from the Major State Basic Research Development Program of China, the Ministry of Science and Technology of the People{\textquoteright}s Republic of China, and the State Key Laboratory for Organ Failure Research, Guangzhou, China. The other authors report no conflicts. Funding Information: 2014B090904040); the Science and Technology Planning Project of Guangzhou, China (201707020010); the Science, Technology and Innovation Committee of Shenzhen (JSGG20160229173428526 and KC2014JSCX0071A); the National Key Research and Development Program (2016YFC0903101 and 2016YFC0904900); the National Clinical Research Center for Kidney Disease, Nanfang Hospital, Nanfang Medical University, Guangzhou, China; the Bureau of Science and Technology of Jiangsu Province with Medical Scientific Specific Fund (BL2014062); and the State Key Laboratory for Organ Failure Research, Nanfang Hospital, Nanfang Medical University, Guangzhou, China. Funding Information: The study was supported by the Projects of National Natural Science Foundation of China (81473052 and 81402735); the Science and Technology Project of Guangdong Province (2009A030100008 and 2014B090904040); the Science and Technology Planning Project of Guangzhou, China (201707020010); the Science, Technology and Innovation Committee of Shenzhen (JSGG20160229173428526 and KC2014JSCX0071A); the National Key Research and Development Program (2016YFC0903101 and 2016YFC0904900); the National Clinical Research Center for Kidney Disease, Nanfang Hospital, Nanfang Medical University, Guangzhou, China; the Bureau of Science and Technology of Jiangsu Province with Medical Scientific Specific Fund (BL2014062); and the State Key Laboratory for Organ Failure Research, Nanfang Hospital, Nanfang Medical University, Guangzhou, China. Publisher Copyright: {\textcopyright} 2017 American Heart Association, Inc. Copyright: Copyright 2018 Elsevier B.V., All rights reserved.",
year = "2018",
doi = "10.1161/STROKEAHA.117.018273",
language = "English (US)",
volume = "49",
pages = "114--120",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "1",
}