The effect of folic acid in patients with cardiovascular disease A systematic review and meta-analysis

Background: The effectiveness of folic acid supplementation in stroke risk has been investigated, however, the available results are inconclusive and conflicting. The purpose of this systemic review and meta-analysis was to assess the effect of folic acid in patients with cardiovascular disease (CVD). Methods: By searching the PubMed, EMBASE, and Cochrane library databases, we conducted a meta-analysis to evaluate effect of folic acid supplementation in patients with CVD. All-cause mortality, cardiovascular mortality, the risk of coronary heart disease (CHD) and stroke were summarized; hazard ratios (HR), the relative risk (RR) and its 95% confidence interval (CI) were also calculated. Fixed effects models were used to combine the data. A total of 12 randomized controlled trials, which involved 47,523 participants, met the inclusion criteria in this systematic review and meta-analysis. Results: Our meta-analysis showed that cardiovascular patients who received folic acid therapy had significantly decreased risk of stroke (RR= 0.85, 95% CI= 0.77-0.94, Pheterogeneity=. 347, I2= 10.6%) compared with patients who received control treatment. However, no significant difference in all-cause mortality (HR, 0.97, 95% CI, 0.86-1.10, Pheterogeneity=. 315, I2= 15.4%), cardiovascular mortality (HR, 0.87, 95% CI, 0.66-1.15, Pheterogeneity=. 567, I2= 0) and risk of CHD (RR, 1.04, 95% CI, 0.99-1.10, Pheterogeneity=. 725, I2= 0) were found between the 2 groups. Conclusion: This meta-analysis suggested that folic acid supplementation significantly reduced the risk of stroke in patients with CVD.