Author: Kirti Salunkhe, MD

Cardiovascular Disease (CVD) is a category of diseases affecting the heart and blood vessels and it is estimated that nearly 90% of CVD is preventable.[1] Amongst the best known ailments in this category of diseases is stroke. Stroke is the leading cause of disability and the 5th most common cause for death in the United States. Prior research has shown lowering serum homocysteine levels leads to reduced incidence of CVD and possibly stroke; however studies on lowering homocysteine with folic acid supplementation for CVD risk has yielded differing results. This meta-analysis from MHICN research collaborators at Erasmus Medical Center, Rotterdam and Harvard’s T.H. Chan’s School of Public Health in Boston, provides the most current information available with additional data from 3 newly completed studies, and 22,510 more patients, which could account for the statistical significance of these data compared to earlier research.

In this study, recently published in the Journal of the American Heart Association,[2] the authors evaluated 30 randomized, controlled, trials from across the globe with over 80,000 participants to determine the effectiveness of folic acid supplementation to lower the risk of CVD and stroke. Of the participants, the mean age was 50 years and 53% were male. The average folic acid supplementation duration was 3.2 years with the dose ranging from .5 to 15 mg/day.

Results from the analysis of 82,334 participants showed:

  • Pooled data of folic acid supplementation indicated a 10% lower relative risk for stroke and 4% reduced risk for overall CVD
    • These improvements were better in participants with lower baseline folate levels
  • Greater overall CVD benefit was noted in participants without pre-existing CVD
  • There was no significant effect of folic acid supplementation on risk of coronary heart disease (CHD)

Why is this clinically important?

Folic acid has long been of interest to support the management of CVD, primarily due to its role in converting homocysteine to methionine. Studies have shown increased homocysteine levels to be linked to increased risk for heart disease, and dietary folate fortification lowers plasma homocysteine levels. This study underscores the need for supplementation with folic acid to improve heart health – particularly in the reduction of risk for stroke.

[1] McGill HC, McMahan CA, Gidding SS. “Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study”. Circulation. 2008, 117 (9): 1216–27.

[2] Li Y, Huang T, Zheng Y et al, “Folic Acid Supplementation and Risk of Cardiovascular Diseases: A Meta-Analysis of Randomized Clinical Trials. J Am Heart Assoc. 2016 Aug 15;5(8)

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