Acid folic làm giảm 21% nguy cơ đột quỵ ở người tăng huyết áp: Thông tin cập nhật 2018 từ đại học tim mạch Mỹ

 Bổ sung acid folic làm giảm 21% nguy cơ đột quỵ ở người tăng huyết áp: Thông tin cập nhật 2018 từ đại học tim mạch Mỹ

TS.BS. Nguyễn Văn Tuấn sưu tập và dịch lược từ website của đại học tim mạch Mỹ

Theo một nghiên cứu được công bố trên Tạp chí của Đại học Hoa Kỳ, những người trưởng thành bị tăng huyết áp với số lượng tiểu cầu thấp, uống một viên thuốc enalapril hàng ngày kết hợp với axit folic đã giảm 73% nguy cơ đột quỵ đầu tiên so với những bệnh nhân chỉ uống đơn thuần enalapril hàng ngày.

Trong một báo cáo được công bố trước đây từ Thử nghiệm phòng ngừa đột quỵ chính của Trung Quốc (CSPPT), các nhà nghiên cứu nhận thấy rằng điều trị bằng axit folic có thể làm giảm trung bình 21% nguy cơ đột quỵ ở người trưởng thành tăng huyết áp bằng cách giảm tổng mức homocysteine . Nghiên cứu hiện tại này là nghiên cứu đầu tiên và lớn nhất thuộc loại nghiên cứu về mối liên quan giữa tăng nồng độ homocysteine và số lượng tiểu cầu. Cả hai đều đóng một vai trò quan trọng trong sự phát triển của bệnh tim mạch.

Các nhà nghiên cứu đã phân tích 10.789 người tham gia là những người đàn ông và phụ nữ từ 45 đến 75 tuổi ở Trung Quốc, bị tăng huyết áp hoặc đang dùng thuốc hạ huyết áp. Nghiên cứu loại trừ bệnh nhân có tiền sử đột quỵ hoặc các bệnh tim mạch lớn khác. Những người tham gia được phân ngẫu nhiên thành hai nhóm. Trong nhóm thứ nhất, 5.408 bệnh nhân đã nhận được liều uống kết hợp hàng ngày là 10 mg enalapril và 0,8 mg axit folic, và trong nhóm thứ hai, 5.381 bệnh nhân chỉ nhận được liều hàng ngày chỉ dùng enalapril….

Hypertensive Patients May Benefit from Folic Acid Supplements

Patients with low platelet count and high homocysteine levels reduced first stroke risk by 73 percent with the B vitamin

May 07, 2018

Contact: Sam Roth,, 202-375-6582

WASHINGTON (May 07, 2018) –

Hypertensive adults with low platelet count who took a combined daily pill of both enalapril and folic acid saw a 73 percent reduction in their risk of first stroke compared to patients who took only enalapril daily, according to a study published in the Journal of the American College of Cardiology.  

Stroke is the second leading cause of death worldwide, and the number one cause of death in China. About 77 percent of strokes are first events, creating a need for better primary prevention efforts.

In an earlier published report from the China Stroke Primary Prevention Trial (CSPPT), researchers found that folic acid treatment could reduce first stroke risk by 21 percent on average in hypertensive adults by lowering total homocysteine levels—elevated levels are a risk factor for vascular disease. This present study is the first and largest of its kind to examine the association of elevated homocysteine levels and platelet count together—both of which play a significant role in the development of cardiovascular disease—with first stroke.

Researchers analyzed 10,789 participants from the CSPPT—men and women aged 45 to 75 years old who had hypertension or were on anti-hypertensive medication. The study excluded patients with a history of stroke or other major cardiovascular diseases. Participants were randomly assigned into two groups. In the first group, 5,408 patients received a combined daily oral dose of 10 mg enalapril and 0.8 mg folic acid, and in the second group, 5,381 patients received a daily dose of only the enalapril.

Among the total number of participants, 371 first strokes took place over a median follow up of 4.2 years. A total of 210 first strokes occurred in the enalapril-only group, and 161 first strokes in the enalapril-folic acid group.

“Our analysis has shown that baseline low platelet count and elevated homocysteine can jointly increase the risk of first stroke,” said Yong Huo, MD, director of the Heart Center of Peking University First Hospital in China, and the study’s senior author. “If the findings are further confirmed by prospective trials, we can raise the prospect that we can identify patients at high risk of developing first stroke by measuring both platelet and homocysteine, and we can remarkably lower stroke risk among this subgroup of patients with folic acid—a simple, safe and inexpensive treatment.”

Researchers found the risk of first stroke reduced from 5.6 percent to 1.8 percent among patients with low platelet count and high homocysteine levels, creating a 73 percent risk reduction. However, the folic acid had no effect among those with high platelet count and low homocysteine levels.

“If confirmed, these results have enormous public health implications given the high incident rate of stroke in many developing countries, in addition to China,” Huo said. “Based on our findings, we can detect hypertensive adults at particular high risk of stroke and incorporate a folic acid supplement tailored to individual genetic, nutritional and clinical characteristics. We are on the right path to figuring out cost-effective primary prevention strategies for stroke in China and beyond.”

In an accompanying editorial, J. David Spence, MD, director of the Stroke Prevention and Atherosclerosis Research Centre at Robarts Research Institute noted that, “Patients with lower platelet counts and higher homocysteine levels are more likely to have higher risk because they had vitamin B12 deficiency. Among folate-replete subjects, the main nutritional determinant of high homocysteine levels is B12 deficiency.” 

Spence said, “The widespread belief that B vitamins do not reduce the risk of stroke is mistaken. This study not only invited confirmation of the benefit of B vitamins, but opens the door to wider applications.”

As a post-hoc analysis of CSPPT, limitations of the study include that residual confounding cannot be completely ruled out. Higher dosages of folic acid should be evaluated for any additional beneficial effects. Further studies should examine platelet parameters during the follow-up period and the utility of 5-methyltetrafolate, a more naturally occurring folate than folic acid.

The study was funded in part by the National Science and Technology Major Projects, the National Key Research Development Program, the Projects of the Natural Science Foundation of China, the Science and Technology Planning Project of Guangzhou, and the Science, Technology and Innovation Committee of Shenzhen.

The American College of Cardiology is the professional home for the entire cardiovascular care team. The mission of the College and its more than 52,000 members is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, offers cardiovascular accreditation to hospitals and institutions, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more, visit

The Journal of the American College of Cardiology ranks among the top cardiovascular journals in the world for its scientific impact. JACC is the flagship for a family of journals—JACC: Cardiovascular InterventionsJACC: Cardiovascular ImagingJACC: Heart FailureJACC: Clinical Electrophysiology and JACC: Basic to Translational Science—that prides themselves in publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at

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