Efficacy of folic acid supplementation in stroke prevention: a meta-analysis.
BACKGROUND
The efficacy of treatments that lower homocysteine concentrations in reducing the risk of cardiovascular disease remains controversial. Our aim was to do a meta-analysis of relevant randomised trials to assess the efficacy of folic acid supplementation in the prevention of stroke.


METHODS
We collected data from eight randomised trials of folic acid that had stroke reported as one of the endpoints. Relative risk (RR) was used as a measure of the effect of folic acid supplementation on the risk of stroke with a random effect model. The analysis was further stratified by factors that could affect the treatment effects.


RESULTS
Folic acid supplementation significantly reduced the risk of stroke by 18% (RR 0.82, 95% CI 0.68-1.00; p=0.045). In the stratified analyses, a greater beneficial effect was seen in those trials with a treatment duration of more than 36 months (0.71, 0.57-0.87; p=0.001), a decrease in the concentration of homocysteine of more than 20% (0.77, 0.63-0.94; p=0.012), no fortification or partly fortified grain (0.75, 0.62-0.91; p=0.003), and no history of stroke (0.75, 0.62-0.90; p=0.002). In the corresponding comparison groups, the estimated RRs were attenuated and insignificant.


CONCLUSIONS
Our findings indicate that folic acid supplementation can effectively reduce the risk of stroke in primary prevention.
Wang
Xiaobin
X
Mary Ann and J Milburn Smith Child Health Research Program, Children's Memorial Hospital and Children's Memorial Research Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: xbwang@childrensmemorial.org.
Qin
Xianhui
X
Institute for Biomedicine, Anhui Medical University, Hefei, China.
Demirtas
Hakan
H
Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA.
Li
Jianping
J
Department of Cardiology, First Hospital of Peking University, Beijing, China.
Mao
Guangyun
G
Institute for Biomedicine, Anhui Medical University, Hefei, China.
Huo
Yong
Y
Department of Cardiology, First Hospital of Peking University, Beijing, China.
Sun
Ningling
N
Department of Cardiology, People's Hospital of Peking University, Beijing, China.
Liu
Lisheng
L
Division of Hypertension, Fu-Wai Hospital, Beijing, China; Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, China.
Xu
Xiping
X
Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA.
D000368:Aged; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D020521:Stroke / Q000517:prevention & control*; D014803:Vitamin B Complex / Q000627:therapeutic use*
D006710:Homocysteine; D014803:Vitamin B Complex; D005492:Folic Acid