Folate Supplements for Stroke Prevention Targeted Trial Trumps the Rest

The effect of folate supplementation on cardiovascular disease has been studied in many observational studies and randomized trials and has been a topic of debate for a number of years. In this issue of JAMA, Huo and colleagues provide results from their important clinical trial of folic acid therapy for primary prevention of stroke. In a carefully designed and executed randomized trial, 20 702 adults with hypertension were randomized to receive enalapril alone (n = 10 354) or enalapril combined with 0.8 mg folic acid (n = 10 348). As recommended by the data and safety monitoring board, the trial was terminated early, after 4.5 years, with emergence of a significant reduction in the incidence of first stroke, the primary end point, of 2.7% (282 events) in the enalapril–folic acid group vs 3.4% (355 events) in the enalapril alone group (hazard ratio, 0.79; 95% CI, 0.68-0.93). In further support of the finding, the benefit was more pronounced in the prespecified subgroup of study participants with the lowest baseline levels of plasma folate (ie,
Source: JAMA - Journal of the American Medical Association - Category: Journals (General) Source Type: research