Can folic acid supplementation prevent stroke in middle-aged and elderly people? Experts say: It is not suitable for everyone

When I was in the outpatient clinic, an old lady came to me and said, "Doctor, do I need to take some folic acid tablets?"

I said: Why do you want to take folic acid tablets?

The old lady said: I heard that it can prevent stroke, but I remember that this medicine is only taken when pregnant, and I don’t know if I dare to take it.

I told the old lady that if she really wanted to find out whether she should take it or not, she needed to do a blood test to see if her homocysteine ​​level was high. If it was high, she could take it, as it could indeed reduce the risk of stroke, but if it was not high, there was no need to take it.

1. What is folic acid?

Folic acid is actually a vitamin, an important nutrient for the body, and an important nutrient for promoting the normal development of the embryonic nervous system. It participates in the metabolism of amino acids. In the decomposition and anabolism of methionine, folic acid is an important carrier substance. If the body lacks folic acid, the conversion of methionine's intermediate metabolite, homocysteine ​​(Hcy), will be blocked, resulting in high homocysteine ​​levels. Folic acid deficiency can reduce hemoglobin production in red blood cells, hinder cell maturation, and lead to megaloblastic anemia.

Pregnant women who lack folic acid may develop cleft lip and palate, so the old lady said that folic acid supplements should be taken during pregnancy, which can prevent cleft lip and palate.

2. Causes of Stroke

Stroke, also known as infarction, is divided into cerebral hemorrhage and cerebral infarction.

Most cerebral hemorrhages are related to hypertension, hyperlipidemia, diabetes, and arteriosclerosis, which are the main causes of cerebral hemorrhage. It may also be related to vascular malformations, aneurysms, coagulation disorders, anticoagulant or antiplatelet drug treatment, thrombolytic therapy, post-infarction hemorrhagic transformation, blood diseases, moyamoya disease, primary or metastatic tumors, venous sinus thrombosis, vasculitis, pregnancy, etc.

The main causes of cerebral infarction: atherosclerosis, cardiogenic thrombosis, cerebral arteriosclerosis and occlusion, hyalinization, etc.

Whether it is cerebral infarction or cerebral hemorrhage, it is related to: high blood pressure, hyperlipidemia, diabetes, hyperhomocysteinemia, heredity, smoking and drinking, obesity, unhealthy diet, smoking and drinking, lack of exercise, staying up late, mental stress, etc.

3. The relationship between folic acid and stroke

Atherosclerosis can increase the risk of cerebral infarction or cerebral hemorrhage; and high homocysteine ​​is an independent risk factor for the aggravation of atherosclerosis. It increases the risk of hypertension by 3 times, and the risk of stroke in hypertension with high homocysteine ​​is 12.1 times higher than that in the normal population. Epidemiological studies have shown that the risk of stroke increases by 59% for every 5µmol/L increase in homocysteine.

Studies have shown that homocysteine ​​can cause oxidative stress, atherosclerosis, endothelial cell damage, etc. The coexistence of high homocysteine ​​and angiotensin can aggravate vascular endothelial damage, and folic acid intake can alleviate this symptom.

Simply put, folic acid can lower high homocysteine ​​levels, thereby reducing the risk of stroke.

How to prevent stroke

For people with hyperhomocysteinemia, folic acid supplementation can indeed reduce the risk of stroke. However, stroke prevention requires a comprehensive and integrated healthy lifestyle: quit smoking and drinking, exercise, eat a healthy diet, control weight, avoid staying up late, and strictly control blood pressure, blood lipids, and blood sugar.

If necessary, some people need to take statins and aspirin for a long time; patients with atrial fibrillation also need to take anticoagulants. Only in this way can the risk of stroke be minimized. It is not enough to just take folic acid to prevent stroke.

5. Foods containing folic acid

Most fruits, vegetables and whole grains contain folic acid, including lettuce, spinach, greens, lentils, bean pods, tomatoes, carrots, pumpkin, mushrooms, rapeseed, Chinese cabbage, kiwi, apples, peaches, pears, plums, apricots, strawberries, cherries, bananas, lemons, bayberry, crabapple, hawthorn, pomegranate, grapes, whole wheat flour, oats, rice bran, brown rice, beans, nuts, etc.

As long as we eat healthily, eat more fruits, vegetables, whole grains and seeds, eat a comprehensive diet, and eat a variety of foods, we can supplement the folic acid our body needs.

6. Do I need to take folic acid tablets to supplement folic acid?

If the average homocysteine ​​level in a blood test is >10umm/L, then hyperhomocysteinemia should be considered and folic acid supplementation is needed. The guidelines recommend folic acid supplementation to reduce plasma homocysteine ​​concentration and reduce the risk of stroke. The recommended daily folic acid supplement is 0.8 mg.

In short, preventing stroke is not as simple as taking folic acid, but mainly depends on a comprehensive healthy lifestyle and strict control of the three highs. Of course, for patients with hypertension, if the average homocysteine ​​level is >10umm/L, folic acid can be appropriately supplemented to minimize the risk of stroke.