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Global Translational Medicine Folic acid for stroke prevention

greater risks in certain populations including those with Writing – original draft: Kate C. Chiang, Ajay Gupta
prior adenomas and vitamin B deficiency. Writing – review & editing: All authors
12
4. Conclusion Ethics approval and consent to participate

CVD is a global health challenge, with hypertension as a Not applicable.
key risk factor. Folic acid supplementation has been shown
to reduce risk of stroke with an associated reduction in Consent for publication
homocysteinemia in hypertensive patients. However, Not applicable.
the cerebrovascular benefits of folic acid are negligible in
patients expressing the MTHFR TT gene polymorphism Availability of data
due to reduced MTHFR enzyme activity, impaired folic Not applicable.
acid metabolism, and persistent active folate deficiency.
Furthermore, accumulation of unmetabolized folic acid References
raises the specter of folic acid toxicity including increased
risk of cancer, immune suppression, and dementia. 1. Tong X, Yang Q, Ritchey MD, et al. The burden of
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Further research is urgently needed to test the efficacy 2. Feigin VL, Owolabi MO, Feigin VL, World Stroke
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approach comprising genetic testing for MTHFR gene global burden of stroke: A World Stroke Organization-Lancet
polymorphisms to guide supplementation with folic acid Neurology Commission. Lancet Neurol. 2023;22:1160-1206.
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of supplementing all patients, irrespective of their MTHFR
genotype, with active folate instead of synthetic folic acid doi: 10.1161/cir.0000000000000350
merits examination. It remains to be examined whether 4. Gorelick PB. New horizons for stroke prevention:
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or 5-MTHF is associated with the increased risk of doi: 10.1016/s1474-4422(02)00070-4
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Acknowledgments 7. GBD 2019 Stroke Collaborators. Global, regional, and

None. national burden of stroke and its risk factors, 1990-2019:
A systematic analysis for the Global Burden of Disease Study
Funding 2019. Lancet Neurol. 2021;20(10):795-820.

None. doi: 10.1016/s1474-4422(21)00252-0
8. Schutte AE, Srinivasapura Venkateshmurthy N, Mohan S,
Conflict of interest Prabhakaran D. Hypertension in low- and middle-income
The authors declare that they have no competing interests. countries. Circ Res. 2021;128(7):808-826.
doi: 10.1161/circresaha.120.318729
Author contributions
9. Rozen R. molecular biology of methylenetetrahydrofolate
Conceptualization: Kate C. Chiang, Ajay Gupta reductase (MTHFR): Interrelationships with folic acid,
Data curation: Teja Kankanala, Priya Kankanala, Prisha Desai homocysteine and vascular disease. In: Robinson K, editor.

Volume 3 Issue 2 (2024) 4 doi: 10.36922/gtm.2509