High cholesterol increases the risk of stroke, and folic acid supplementation reduces the risk of first stroke in patients with high cholesterol and hypertension by 31%

Source: according to the csppt study subgroup analysis conducted by Huo Yong, the first hospital of Peking University, China Journal of circulation, October 31, 2016, hypercholesterolemia is an independent risk factor for the first stroke in hypertensive patients, while folic acid supplementation for hypertensive people with hypercholesterolemia can reduce the risk of the first stroke by 31% In this study, the researchers first compared the effects of total cholesterol level ≥ 200 mg / dl and < 200 mg / dl on the first stroke in patients with hypertension The results showed that the incidence of stroke in the former was much higher than that in the latter (4% vs 2.6%); total cholesterol level ≥ 200 mg / dl was an independent risk factor for the first stroke in patients with hypertension After folic acid supplementation for subjects with different total cholesterol levels, the researchers found that the relationship between folic acid supplementation and stroke risk reduction was not significant for subjects with total cholesterol levels < 200 mg / dl, but for patients with hypertension with total cholesterol levels ≥ 200 mg / dl, folic acid supplementation daily reduced the risk of first stroke by 31% , and this reduction is independent of baseline folate levels and other important risk factors Figure 1 incidence of first stroke and ischemic stroke with or without folic acid supplementation in patients with hypertension with different total cholesterol levels Figure 2 Kaplan Meier curve of first stroke accumulation risk in patients with hypertension with different total cholesterol levels The burden of disease is heavy in China A previous national study showed that 32.8% of the population aged 35-74 had total cholesterol level ≥ 200 mg / dl The researchers pointed out that although statins are important drugs for lipid regulation, 10% - 15% of patients are not tolerant in practice, and will face myopathy, new diabetes and other adverse reactions, while other lipid-lowering drugs are uncertain in the primary prevention of stroke in people who are not tolerant to statins In addition, the proportion of patients with cardiovascular disease using statins in China is relatively low In addition, ACC / AHA recommended starting statins for LDL-C ≥ 190 mg / dl, diabetes mellitus, estimated 10-year cardiovascular event risk ≥ 7.5% In this study, the researchers excluded the above patients and found that those with LDL ≥ 100 mg / dl and < 190mg / dl could also benefit from folic acid supplementation This suggests that folic acid supplementation can also benefit the low-risk population In conclusion, the researchers believe that folic acid supplementation is safe and low-cost for hypertension patients with high total cholesterol level, which is of great significance for stroke prevention, especially for those who fail to take statins This randomized double-blind study included 20166 hypertension patients without major cardiovascular history, and none of them took lipid-lowering drugs, including 11862 patients with total cholesterol level ≥ 200 mg / dl and 8304 patients with total cholesterol level < 200 mg / dl The researchers randomly divided them into two groups: one group was given enalapril (10 mg) + folic acid (0.8 mg) every day; the other group was given only enalapril (10 mg) every day The median treatment time was 4.5 years.