机构：[1]Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China[2]Department of Cardiology ,Peking University First Hospital, Beijing, China[3]Department of Neurology, Peking University First Hospital, Beijing, China[4]Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, University of Western Ontario, London, Canada[5]Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD[6]Department of Cardiology, Peking University People’s Hospital, Beijing, China[7]Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China首都医科大学附属安贞医院[8]Department of Cardiology, Peking University Third Hospital, Beijing, China[9]Department of Cardiology, First People’s Hospital, Lianyungang, China[10]Department of Cardiology, Second People’s Hospital, Lianyungang, China[11]Institute for Biomedicine, School of Health Administration, Anhui Medical University, Hefei, China[12]Department of Neurology, First Affiliated Hospital, Anhui Medical University, Hefei, China[13]Department of Neurology, First People’s Hospital, Lianyungang, China[14]Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China广东省中医院[15]Department of Geriatric Cardiology, the General Hospital of the People’s Liberation Army, Beijing, China[16]Department of Cardiology, Second Xiangya Hospital, Central South University, Changsha, China[17]Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China四川大学华西医院[18]Department of Cardiology, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, China[19]Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China江苏省人民医院
Background and Purpose-We sought to determine whether folic acid supplementation can independently reduce the risk of first stroke associated with elevated total cholesterol levels in a subanalysis using data from the CSPPT (China Stroke Primary Prevention Trial), a double-blind, randomized controlled trial. Methods-A total of 20702 hypertensive adults without a history of major cardiovascular disease were randomly assigned to a double-blind daily treatment of an enalapril 10-mg and a folic acid 0.8-mg tablet or an enalapril 10-mg tablet alone. The primary outcome was first stroke. Results-The median treatment duration was 4.5 years. For participants not receiving folic acid treatment (enalapril-only group), high total cholesterol (>= 200 mg/dL) was an independent predictor of first stroke when compared with low total cholesterol (<200 mg/dL; 4.0% versus 2.6%; hazard ratio, 1.52; 95% confidence interval, 1.18-1.97; P=0.001). Folic acid supplementation significantly reduced the risk of first stroke among participants with high total cholesterol (4.0% in the enalapril-only group versus 2.7% in the enalapril-folic acid group; hazard ratio, 0.69; 95% confidence interval, 0.56-0.84; P<0.001; number needed to treat, 78; 95% confidence interval, 52-158), independent of baseline folate levels and other important covariates. By contrast, among participants with low total cholesterol, the risk of stroke was 2.6% in the enalapril-only group versus 2.5% in the enalapril-folic acid group (hazard ratio, 1.00; 95% confidence interval, 0.75-1.30; P=0.982). The effect was greater among participants with elevated total cholesterol (P for interaction=0.024). Conclusions-Elevated total cholesterol levels may modify the benefits of folic acid therapy on first stroke. Folic acid supplementation reduced the risk of first stroke associated with elevated total cholesterol by 31% among hypertensive adults without a history of major cardiovascular diseases.
基金：
Shenzhen Ausa Pharmed Co Ltd
and national, provincial, and private funding, including funding
from the following: The Major State Basic Research Development
Program of China (program 973; grant No. 2012 CB517703); the
National Science and Technology Major Projects Specialized for
Major New Drugs Innovation and Development during the 12th
Five-Year Plan Period: China Stroke Primary Prevention Trial, grant
No. zx09101105, Clinical Center Grant, grant No. zx09401013; the
projects of National Natural Science Foundation of China (grant No.
81473052, 81441091, and 81402735); the National Clinical Research
Center for Kidney Disease, Nanfang Hospital, Nanfang Medical
University, Guangzhou, China; the State Key Laboratory for Organ
Failure Research, Nanfang Hospital, Nanfang Medical University,
Guangzhou, China; and research grants from the Department of
Development and Reform, Shenzhen Municipal Government (grant
No. SFG 20201744).
第一作者机构：[1]Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China
共同第一作者：
通讯作者：
通讯机构：[2]Department of Cardiology ,Peking University First Hospital, Beijing, China[3]Department of Neurology, Peking University First Hospital, Beijing, China[*1]Department of Neurology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing 100034, China[*2]Department of Cardiology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing 100034, China
推荐引用方式(GB/T 7714)：
Xianhui Qin,Jianping Li,J. David Spence,et al.Folic Acid Therapy Reduces the First Stroke Risk Associated With Hypercholesterolemia Among Hypertensive Patients[J].STROKE.2016,47(11):2805-2812.doi:10.1161/STROKEAHA.116.014578.
APA：
Xianhui Qin,Jianping Li,J. David Spence,Yan Zhang,Youbao Li...&Yong Huo.(2016).Folic Acid Therapy Reduces the First Stroke Risk Associated With Hypercholesterolemia Among Hypertensive Patients.STROKE,47,(11)
MLA：
Xianhui Qin,et al."Folic Acid Therapy Reduces the First Stroke Risk Associated With Hypercholesterolemia Among Hypertensive Patients".STROKE 47..11(2016):2805-2812
医学