The combined use of enalapril and folic acid significantly reduced the risk of first stroke compared with enalapril alone, a study published in the Journal of the American Medical Association has shown. Findings from the study are also being presented at the American College of Cardiology’s 64th Annual Scientific Session and Expo.

The China Stroke Primary Prevention Trial evaluated 20,072 adults in China with high blood pressure without a history of stroke or heart attack between May 2008 to August 2013. . Patients were randomized to enalapril 10mg plus folic acid 0.8mg or enalapril 10mg alone. Patients were tested for variations in the MTHFR C677T gene (CC, CT, and TT genotypes) that may affect folate levels.

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Study data showed the first stroke occurred in 2.7% of the enalapril plus folic acid group (n=282) vs. 3.4% in the enalapril alone group (n=355) during a median treatment duration of 4.5 years (absolute risk reduction 0.7% and relative risk reduction 21%). Significant reductions in ischemic stroke (2.2% vs. 2.8%) and composite cardiovascular events (3.1% vs.3.9%) were seen among enalapril plus folic acid group; cardiovascular events include cardiovascular death, heart attack, and stroke. No significant difference was seen in the risk of hemorrhagic stroke, heart attack, all-cause death, or in the frequency of adverse events between groups.

The study authors conclude that baseline folate levels may be an important factor in the efficacy of folic acid therapy in stroke prevention. The varied plasma folate levels show that those with lower levels in the study received a greater treatment benefit.

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