Drop in US and Canadian stroke mortality rate coincides with folic acid fortification
A report published in the March 14, 2006 issue of the American Heart Association journal Circulation summarized the finding of Quanhe Yang, PhD of the Centers for Disease Control and colleagues that the acceleration of the rate of decline in stroke mortality observed in the United States and Canada from 1998 to 2002 coincides with the implementation of mandatory fortification of grain products with folic acid in these countries beginning in 1998. Folic acid, a member of the B vitamin family, has been found to help prevent spina bifida, a major birth defect, if present in the diet in sufficient amounts, yet many individuals are deficient in folic acid due to a lack of leafy green vegetables and other sources of the vitamin in their diets.
The research team calculated age-adjusted stroke mortality per 100,000 US residents and obtained similar data for Canada, England and Wales for 1990 to 1997, and 1998 to 2002. Stroke data for England and Wales was used for comparison with the US and Canada, since Great Britain has not implemented folic acid fortification. Additionally, analyses utilizing National Health and Nutrition Examination Survey (NHANES) data obtained during 1998 to 1991, 1991 to 1994, and 1999 to 2000 evaluated changes in blood folate and total cysteine as well as changes in stroke risk factors.
Blood folate levels were found to increase and total homocysteine decrease in men and women forty years of age or more following folic acid fortification. Although stroke mortality declined over the entire period from 1990 to 2002 in all countries examined, the rate of decline after 1998 compared to the previous eight years accelerated in nearly all of the demographic groups examined in the United States and Canada, while the rate continued the previous linear downward trend in England and Wales. The drop in the percentage of stroke deaths in Canada was more dramatic than that in the US. While stroke deaths declined, there was no evidence of a decrease in the incidence of stroke.
“The timing of the accelerated decline in stroke mortality in our study is generally consistent with the timing of fortification, and the degree of decline is consistent with what was predicted for the change in blood homocysteine concentrations observed in the US population,” the authors conclude. “If folic acid fortification is responsible for even a fraction of the accelerated improvement we observed, this public health benefit is an important bonus to the reduction in neural tube defect rates previously demonstrated.”
Researchers have conducted thousands of clinical trials searching for better ways to prevent and treat stroke victims. As a result, we have a robust knowledge of cerebrovascular disease, and we are learning more every day. As with atherosclerosis in the coronary arteries (coronary artery disease), the underlying cause of ischemic stroke can often be traced back decades, to early insults to the inner lining (endothelium) of the arteries that set a deadly chain reaction into motion. Now that they have identified endothelial dysfunction as a fundamental process of cardiovascular and cerebrovascular disease, along with the prime risk factors for endothelial dysfunction, such as high blood pressure and smoking, researchers are pursuing new therapies aimed at preventing strokes by improving the health of our arteries.
The following dietary supplements may help improve endothelial function and cerebral blood flow and reduce the risk of stroke:
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