NEW YORK (Reuters Health) – After folic acid fortification
of enriched grain products was fully implemented in 1998,
deaths due to strokes dropped rapidly in the US and Canada,
according to a report in the American Heart Association’s
journal Circulation.
The main reason for folic acid fortification was to reduce
the number of babies born with neural tube defects such as
spina bifida. The present findings suggest, however, that there
may have been an unintended benefit.
There is “accumulating, controversial evidence” that
homocysteine — an amino acid in the blood — is a risk factor
for stroke and heart disease, Dr. Quanhe Yang, from the Centers
for Disease Control and Prevention in Atlanta, said in a
statement. Folate decreases homocysteine levels, which may help
explain the drop in stroke deaths.
Yang’s team compared stroke mortality trends between 1990
and 2002 in the US and Canada with those in England and Wales,
where folate fortification is not required.
Stroke mortality was already falling in the US and Canada
from 1990 to 1997, but in 1998 a precipitous drop began, the
report indicates. In the US, the annual decrease in mortality
during the earlier period was 0.3 percent, whereas starting in
1998 the reduction was 2.9 percent. Similar results were seen
in Canada.
By contrast, stroke mortality rates did not decline
significantly in England and Wales between 1990 and 2002, the
report indicates.
“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,” Yang and
colleagues conclude.
SOURCE: Circulation, March 14, 2006.
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