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Systematic review
Meta analysis suggests that folic acid supplementation does not reduce risk of stroke, but there may be some benefit when given in combination with vitamins B6 and B12 and in primary prevention
  1. Gustavo Saposnik
  1. Stroke Outcomes Research Unit, St. Michael's Hospital, University of Toronto, Toronto, Canada
  1. Correspondence to Gustavo Saposnik
    55 Queen St East, Suite 931, St Michael's Hospital, University of Toronto, Toronto M5C 1R6, Canada; saposnikg{at}

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Hyperhomocysteinemia has been associated with premature atherosclerosis with an increased risk of cardiovascular events.1,,3 Folate and cyanocobalamin (vitamin B12) are important regulators of the metabolism of homocysteine, and studies have shown an inverse relationship between levels of these factors and levels of homocysteine in the blood.4 5 On the basis of epidemiological studies, clinicians and scientists expected that homocysteine-lowering therapy (HLT) would reduce the incident risk of cardiovascular diseases (including stroke). As a result, HLT has been tested in several randomised clinical trials.6,,9


In the present study, Lee and colleagues report the results of a meta-analysis including randomised, controlled trials assessing the efficacy of folic acid supplementation in the prevention of stroke. They used a strict inclusion criteria: (1) randomised, controlled study; (2) comparison of folic acid supplementation (with or without vitamins B6 and B12) with inactive or low-dose control; (3) the duration of the intervention was longer than 6 months; and (4) study reporting on the number of stroke events in both active …

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  • Competing interests GS received research funding from the Heart and Stroke Foundation of Onatario, Canada, the Canadian Institutes for Health Research, Department of Research at St Michael's Hospital and Connaught Foundation (University of Toronto).