Efficacy of homocysteine-lowering therapy with folic Acid in stroke prevention: a meta-analysis

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Efficacy of homocysteine-lowering therapy with folic Acid in stroke prevention: a meta-analysis

Lee et al., 2010 | Stroke | Meta Analysis

Citation

Lee Meng, Hong Keun-Sik, ... Saver Jeffrey L. Efficacy of homocysteine-lowering therapy with folic Acid in stroke prevention: a meta-analysis. Stroke. 2010-Jun;41(6):1205-12. doi:10.1161/STROKEAHA.109.573410

Abstract

BACKGROUND AND PURPOSE: Although a lower serum homocysteine concentration is associated with a reduced risk of stroke in epidemiologic studies, randomized, controlled trials have yielded mixed findings regarding the effect of therapeutic homocysteine lowering on stroke prevention. We performed a meta-analysis of randomized, controlled trials to assess the efficacy of folic acid supplementation in the prevention of stroke. METHODS: Salient trials were identified by formal literature search. Relative risk (RR) with 95% CI was used as a measure of the association between folic acid supplementation and risk of stroke, after pooling data across trials in a fixed-effects model. RESULTS: The search identified 13 randomized, controlled trials that had enrolled 39 005 participants for folic acid therapy to reduce homocysteine in which stroke was reported as an outcome measure. Across all trials, folic acid supplementation was associated with a trend toward mild benefit that did not reach statistical significance in reducing the risk of stroke (RR=0.93; 95% CI, 0.85-1.03; P=0.16). The RR for nonsecondary prevention trials was 0.89 (95% CI, 0.79-0.99; P=0.03). In stratified analyses, a greater beneficial effect was seen in the trials testing combination therapy of folic acid plus vitamins B6 and B12 (RR=0.83; 95% CI, 0.71-0.97; P=0.02) and in the trials that disproportionately enrolled male patients (men:women >2; RR=0.84; 95% CI, 0.74-0.94; P=0.003). CONCLUSIONS: Folic acid supplementation did not demonstrate a major effect in averting stroke. However, potential mild benefits in primary stroke prevention, especially when folate is combined with B vitamins and in male patients, merit further investigation.

Key Findings

The search identified 13 randomized, controlled trials that had enrolled 39 005 participants for folic acid therapy to reduce homocysteine in which stroke was reported as an outcome measure. Across all trials, folic acid supplementation was associated with a trend toward mild benefit that did not reach statistical significance in reducing the risk of stroke (RR=0.93; 95% CI, 0.85-1.03; P=0.16). The RR for nonsecondary prevention trials was 0.89 (95% CI, 0.79-0.99; P=0.03). In stratified analyses

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 005
Age Range See abstract
Condition See abstract

MeSH Terms

  • Female
  • Folic Acid
  • Homocysteine
  • Humans
  • Male
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Sex Factors
  • Stroke
  • Vitamin B 12
  • Vitamin B 6
  • Vitamin B Complex

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't
  • Vertical: folate

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09