SAN DIEGO — Folic acid plus enalapril reduced the risk for first stroke compared with enalapril alone among adults with hypertension in China, according to data presented at the American College of Cardiology Scientific Sessions.
The randomized, double blind China Stroke Primary Prevention Trial was conducted in 32 communities in China in 20,702 adults with hypertension and no history of stroke or MI. Patients were stratified by MTHFR C677T genotypes and then were randomly assigned to double blind daily treatment with enalapril 10 mg plus folic acid 0.8 mg or enalapril 10 mg alone.
The median treatment duration was 4.5 years. Patients assigned enalapril/folic acid had significantly reduced risk for first stroke (2.7% vs. 3.4%; HR = 0.79; 95% CI, 0.68-0.93), first ischemic stroke (2.2% vs. 2.8%; HR = 0.76; 95% CI, 0.64-0.91) and composite CV events including CV death, MI and stroke (3.1% vs. 3.9%; HR = 0.8; 95% CI, 0.69-0.92).
Risk for hemorrhagic stroke (HR = 0.93; 95% CI, 0.65-1.34), all-cause death (HR = 0.94; 95% CI, 0.81-1.1) and MI (HR = 1.04; 95% CI, 0.6-1.82) were similar between the treatment groups.
In other results, the frequency of adverse events was similar with enalapril/folic acid and enalapril alone.
In other results, stratified analyses showed no major interaction of MTHFR C677T genotypes; however, the preventive effect on stroke was more prominent in patients with CC or CT genotypes and lower folate levels at baseline. Researchers said this is evidence that baseline folate levels can determine the effects of folic acid therapy for the prevention of stroke.
“In this population without folic acid fortification, we observed considerable individual variation in plasma folate levels and clearly showed that the beneficial effect appeared to be more pronounced in participants with lower folate levels,” the researchers said. “…We speculate that even in countries with folic acid fortification and widespread use of folic acid supplements such as in the United States and Canada, there may still be room to further reduce stroke incidence using more targeted folic acid therapy — in particular, among those with the TT genotype and low or moderate folate levels.” – by Stephanie Viguers
Huo Y, et al. Abstract 505-12. Presented at: American College of Cardiology Scientific Sessions; March 13-16; San Diego.
Huo Y. JAMA. 2015;doi:10.1001/jama.2015.2274.
Disclosure: Huo reports receiving grants from the National Major Scientific and Technological Special Project and nonfinancial support from Shenzhen AUSA.