Abstract 198: Lifetime Clinical Benefit of Folic Acid Therapy for Primary Prevention of Stroke in Patients with Hypertension - Projection Based on the CSPPT

Background: The CSPPT (China Stroke Primary Prevention Trial) demonstrated a significant risk reduction of first stroke in hypertensive patients treated with EPFA (enalapril plus folic acid) compared to those with enalapril alone, but the life time clinical benefit associated with the use of EPFA is unknown. In this study, we evaluated and quantified the net lifetime clinical benefit of EPFA vs. enalapril alone via assessing stroke-fee life expectancy. Methods: By establishing adjusted models for competing risks and an age-based time scale using data from 19, 053 participants of the CSPPT, we estimated lifetime incremental stroke-free life expectancy for EPFA vs. enalapril alone. Results: Compared with enalapril alone, lifetime EPFA treatment projected a mean stroke-free survival gain of 1.75 months, with an interquartile range months from 0.96 to 4.06 months and the maximum gain up to 12.95 months ( Table 1 ). Subgroup analysis showed greater gain in stroke-free survival in younger male patients, and those with lower baseline folate levels, higher systolic blood pressure, higher total cholesterol and blood glucose, and with methylenetetrahydrofolate reductase (MTHFR) C677T CT or TT genotype; the net benefit of stroke-free life expectancy varies from 3.5 months to 5.3 months among subgroup ( Figure 1 ). Conclusions: Our analyses projected that compared with enalapril alone, enalapril plus folic acid treatment in patients with hypertension is associated with a modest gain in lifetime stroke-free life expectancy. Younger male patients and those with lower baseline folate levels, and higher systolic blood pressure, total cholesterol and blood glucose, and the MTHFR C677T CT or TT genotype are expected to benefit most from the treatment.