Folic acid fortification may have lowered stroke deaths

SAN FRANCISCO, March 5 Fortifying enriched grain products with folic acid in the 1990s appears to have been followed by a decline in stroke and ischemic heart disease deaths, government researchers reported today at the American Heart Association's 44th annual Conference on Cardiovascular Disease Epidemiology and Prevention.

"We found evidence of a three-fold acceleration in the decline of stroke-associated mortality that is temporally related to fortification of flour with folic acid," said study investigator Lorenzo D. Botto, M.D., a medical epidemiologist with the Centers for Disease Control and Prevention's National Center on Birth Defects and Developmental Disabilities in Atlanta. "If folic acid fortification is responsible for the improvement in stroke-associated mortality, the public health benefits are substantial."

The research team, led by Dr. Quanhe Yang, estimated that 31,000 stroke-associated deaths and 17,000 deaths related to ischemic heart disease may have been prevented each year since fortification was implemented.

In 1996, the United States Food and Drug Administration required enriched grain products be fortified with folic acid to reduce the risk of neural tube defects in newborns. The researchers hypothesized that fortification might offer a secondary benefit of reducing serum homocysteine concentrations in the population as a whole, which might lead to a decline in death rates due to cardiovascular disease and stroke.

"Many studies have shown that folic acid can lower serum homocysteine levels, and that people with higher-than-average homocysteine levels are at higher risk for stroke and heart disease," Botto said. "We think high homocysteine somehow causes an insult on the vascular wall, weakening the vessel and making it more prone to damage.

The researchers analyzed national death certificate data to assess mortality rates for cardiovascular disease and stroke in the United States among people 40 or older, from 1

Contact: Carole Bullock
American Heart Association

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