There is renewed interest in health benefits of folic acid supplementation since the China Stroke Prevention Primary Prevention Trial (CSPPT) showed the potential benefits of folic acid in preventing stroke in Chinese adults with hypertension.1 It has long been known that folic acid prevents neural tube defects, which are among the most severe and debilitating congenital birth defects worldwide. The CSPPT was terminated early when 800 µg of folic acid in combination with 10 mg of enalapril significantly reduced primary stroke incidence compared with the enalapril alone treatment arm. This finding was unexpected as other studies had failed to find a preventive effect of folic acid supplementation on cardiovascular events.2 In this issue of JAMA Internal Medicine, Xu et al3 report findings from a prespecified CSPPT substudy that demonstrated that the folic acid–enalapril combination was more effective than enalapril alone in the secondary prevention of renal function decline among Chinese adults with hypertension across a spectrum of mild to moderate chronic kidney disease (CKD).
Stover PJ, Berry RJ, Field MS. Time to Think About Nutrient Needs in Chronic Disease. JAMA Intern Med. 2016;176(10):1451–1452. doi:10.1001/jamainternmed.2016.4699
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