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Efficacy of folic acid supplementation in cardiovascular disease prevention: an updated meta-analysis of randomized controlled trials.
Eur J Intern Med 2012; 23(8):745-54EJ

Abstract

BACKGROUND

In observational studies, lower serum homocysteine levels are associated with a lower incidence of cardiovascular disease (CVD). However, individual randomized controlled trials (RCTs) have yielded mixed findings regarding the efficacy of therapeutic homocysteine in lowering cardiovascular risk. Our aim was to perform an updated meta-analysis of relevant RCTs to assess the efficacy of folic acid supplementation in the prevention of CVD, coronary heart disease (CHD), and stroke.

METHODS

We performed systematic search to identify RCTs reported at least one of the CVD, CHD, or stroke as outcomes. Relative risk (RR) with 95% confidence interval was used as a measure of the association between folic acid supplementation and risk of CVD, CHD, stroke, and all-cause mortality. The analysis was further stratified by factors that could affect the treatment effects.

RESULTS

The systematic search identified 26 RCTs enrolling 58,804 participants. Pooling the RRs showed that folic acid supplementation was not associated with any significant change in the risk of CVD (RR 0.98, 0.95 to 1.02; p=0.36), CHD (RR 1.03, 0.98 to 1.08; p=0.23), and all-cause mortality (RR 1.00, 0.96 to 1.04; p=0.92), but was linked to a decreasing trend in stroke risk (RR 0.93, 0.86 to 1.00; p=0.05). In stratified analyses, the only heterogeneity was found for stroke risk reduction among groups with (RR 1.07, 0.92 to 1.25) vs. without (RR 0.88, 0.81 to 0.96) mandatory grain fortification (P for heterogeneity=0.03).

CONCLUSIONS

This meta-analysis suggests that there might be a potentially modest benefit of folic acid supplementation in stroke prevention.

Authors+Show Affiliations

Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang Gung University College of Medicine, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22884409

Citation

Yang, Hsin-Ta, et al. "Efficacy of Folic Acid Supplementation in Cardiovascular Disease Prevention: an Updated Meta-analysis of Randomized Controlled Trials." European Journal of Internal Medicine, vol. 23, no. 8, 2012, pp. 745-54.
Yang HT, Lee M, Hong KS, et al. Efficacy of folic acid supplementation in cardiovascular disease prevention: an updated meta-analysis of randomized controlled trials. Eur J Intern Med. 2012;23(8):745-54.
Yang, H. T., Lee, M., Hong, K. S., Ovbiagele, B., & Saver, J. L. (2012). Efficacy of folic acid supplementation in cardiovascular disease prevention: an updated meta-analysis of randomized controlled trials. European Journal of Internal Medicine, 23(8), pp. 745-54. doi:10.1016/j.ejim.2012.07.004.
Yang HT, et al. Efficacy of Folic Acid Supplementation in Cardiovascular Disease Prevention: an Updated Meta-analysis of Randomized Controlled Trials. Eur J Intern Med. 2012;23(8):745-54. PubMed PMID: 22884409.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of folic acid supplementation in cardiovascular disease prevention: an updated meta-analysis of randomized controlled trials. AU - Yang,Hsin-Ta, AU - Lee,Meng, AU - Hong,Keun-Sik, AU - Ovbiagele,Bruce, AU - Saver,Jeffrey L, Y1 - 2012/08/11/ PY - 2012/04/12/received PY - 2012/06/28/revised PY - 2012/07/03/accepted PY - 2012/8/14/entrez PY - 2012/8/14/pubmed PY - 2013/4/20/medline SP - 745 EP - 54 JF - European journal of internal medicine JO - Eur. J. Intern. Med. VL - 23 IS - 8 N2 - BACKGROUND: In observational studies, lower serum homocysteine levels are associated with a lower incidence of cardiovascular disease (CVD). However, individual randomized controlled trials (RCTs) have yielded mixed findings regarding the efficacy of therapeutic homocysteine in lowering cardiovascular risk. Our aim was to perform an updated meta-analysis of relevant RCTs to assess the efficacy of folic acid supplementation in the prevention of CVD, coronary heart disease (CHD), and stroke. METHODS: We performed systematic search to identify RCTs reported at least one of the CVD, CHD, or stroke as outcomes. Relative risk (RR) with 95% confidence interval was used as a measure of the association between folic acid supplementation and risk of CVD, CHD, stroke, and all-cause mortality. The analysis was further stratified by factors that could affect the treatment effects. RESULTS: The systematic search identified 26 RCTs enrolling 58,804 participants. Pooling the RRs showed that folic acid supplementation was not associated with any significant change in the risk of CVD (RR 0.98, 0.95 to 1.02; p=0.36), CHD (RR 1.03, 0.98 to 1.08; p=0.23), and all-cause mortality (RR 1.00, 0.96 to 1.04; p=0.92), but was linked to a decreasing trend in stroke risk (RR 0.93, 0.86 to 1.00; p=0.05). In stratified analyses, the only heterogeneity was found for stroke risk reduction among groups with (RR 1.07, 0.92 to 1.25) vs. without (RR 0.88, 0.81 to 0.96) mandatory grain fortification (P for heterogeneity=0.03). CONCLUSIONS: This meta-analysis suggests that there might be a potentially modest benefit of folic acid supplementation in stroke prevention. SN - 1879-0828 UR - https://www.unboundmedicine.com/medline/citation/22884409/Efficacy_of_folic_acid_supplementation_in_cardiovascular_disease_prevention:_an_updated_meta_analysis_of_randomized_controlled_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0953-6205(12)00179-3 DB - PRIME DP - Unbound Medicine ER -