Efficacy of folic acid supplementation in stroke prevention: New insight from a meta-analysis

Yong Huo, X. Qin, J. Wang, N. Sun, Q. Zeng, X. Xu, L. Liu, X. Xu, Xiaobin Wang

Research output: Contribution to journalArticle

Abstract

Aims: There are growing data and a continuing controversy over the efficacy of folic acid supplementation in stroke prevention. We conducted a meta-analysis based on relevant, up-to-date published randomised trials to further examine this issue. Methods: Relative risk (RR) was used to measure the effect of folic acid supplementation on risk of stroke with a fixed-effects model. Results: Overall, folic acid supplementation reduced the risk of stroke by 8% (n = 55,764; RR: 0.92; 95% CI: 0.86-1.00, p = 0.038). In the 10 trials with no or partial folic acid fortification (n = 43,426), the risk of stroke was reduced by 11% (0.89; 0.82-0.97, p = 0.010). Within these trials, a greater beneficial effect was observed among trials with a lower percent use of statins [≤ 80% (median); 0.77; 0.64-0.92, p = 0.005], and a meta-regression analysis also suggested a positive dose-response relationship between percent use of statins and log-RR for stroke associated with folic acid supplementation (p = 0.013). A daily dose of 0.4-0.8mg folic acid appeared to be adequate for stroke prevention in comparison with larger doses. In the remaining five trials conducted in populations with folic acid fortification (n = 12,338), folic acid supplementation had no effect on stroke risk (1.03; 0.88-1.21, p = 0.69). Conclusions: Our analysis indicated that folic acid supplementation is effective in stroke prevention in populations with no or partial folic acid fortification. In addition, a greater beneficial effect was observed among trials with a lower percent use of statins. Our findings underscore the importance of identifying target populations that can particularly benefit from folic acid therapy.

Original languageEnglish (US)
Pages (from-to)544-551
Number of pages8
JournalInternational Journal of Clinical Practice
Volume66
Issue number6
DOIs
StatePublished - Jun 2012

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Folic Acid
Meta-Analysis
Stroke
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Health Services Needs and Demand
Population
Regression Analysis

ASJC Scopus subject areas

  • Medicine(all)

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Efficacy of folic acid supplementation in stroke prevention : New insight from a meta-analysis. / Huo, Yong; Qin, X.; Wang, J.; Sun, N.; Zeng, Q.; Xu, X.; Liu, L.; Xu, X.; Wang, Xiaobin.

In: International Journal of Clinical Practice, Vol. 66, No. 6, 06.2012, p. 544-551.

Research output: Contribution to journalArticle

Huo, Yong ; Qin, X. ; Wang, J. ; Sun, N. ; Zeng, Q. ; Xu, X. ; Liu, L. ; Xu, X. ; Wang, Xiaobin. / Efficacy of folic acid supplementation in stroke prevention : New insight from a meta-analysis. In: International Journal of Clinical Practice. 2012 ; Vol. 66, No. 6. pp. 544-551.
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abstract = "Aims: There are growing data and a continuing controversy over the efficacy of folic acid supplementation in stroke prevention. We conducted a meta-analysis based on relevant, up-to-date published randomised trials to further examine this issue. Methods: Relative risk (RR) was used to measure the effect of folic acid supplementation on risk of stroke with a fixed-effects model. Results: Overall, folic acid supplementation reduced the risk of stroke by 8{\%} (n = 55,764; RR: 0.92; 95{\%} CI: 0.86-1.00, p = 0.038). In the 10 trials with no or partial folic acid fortification (n = 43,426), the risk of stroke was reduced by 11{\%} (0.89; 0.82-0.97, p = 0.010). Within these trials, a greater beneficial effect was observed among trials with a lower percent use of statins [≤ 80{\%} (median); 0.77; 0.64-0.92, p = 0.005], and a meta-regression analysis also suggested a positive dose-response relationship between percent use of statins and log-RR for stroke associated with folic acid supplementation (p = 0.013). A daily dose of 0.4-0.8mg folic acid appeared to be adequate for stroke prevention in comparison with larger doses. In the remaining five trials conducted in populations with folic acid fortification (n = 12,338), folic acid supplementation had no effect on stroke risk (1.03; 0.88-1.21, p = 0.69). Conclusions: Our analysis indicated that folic acid supplementation is effective in stroke prevention in populations with no or partial folic acid fortification. In addition, a greater beneficial effect was observed among trials with a lower percent use of statins. Our findings underscore the importance of identifying target populations that can particularly benefit from folic acid therapy.",
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