The findings suggest that stroke incidence can be significantly reduced with targeted folic acid therapy.

The study published in The Journal of the American Medical Association (JAMA) included more than 20,000 adults in China with high blood pressure but without a history of stroke or heart attack.

Yong Huo from Peking University First Hospital, Beijing, China, and colleagues randomly assigned the participants to receive daily treatment with a single pill combination containing enalapril (10mg) and folic acid, or a tablet containing enalapril alone.

The trial was conducted from May 2008 to August 2013 in 32 communities in Jiangsu and Anhui provinces in China.

Analyses also showed significant reductions among participants in the enalapril-folic acid group in the risk of ischemic stroke (2.2 percent vs 2.8 percent) and composite cardiovascular events (cardiovascular death, heart attack and stroke) (3.1 percent vs 3.9 percent).

The study has provided convincing evidence that baseline folate level is an important determinant of efficacy of folic acid therapy in stroke prevention, the authors said.

"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," they said.

Ideally, adequate folate levels would be achieved from food sources such as vegetables (especially dark green leafy vegetables), fruits and fruit juices, nuts, beans, and peas.

In populations, where achieving adequate levels from diet alone is difficult, folic acid  fortification programmes or supplementation should be considered, the authors added.


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