Folate (methylfolate vs folic acid) and stroke

What 2 graded rows on folate (methylfolate vs folic acid) agree on for stroke, and where they differ. Counted side by side, never averaged.

Consensus finder Rows from the Folate (methylfolate vs folic acid) page, reviewed Oct 21, 2026 How it decides

What the rows agree on

Each block and row is one graded row from the Folate (methylfolate vs folic acid) page, with its PubMed record.

Supplement

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2 rows · 136,261 people

They agree: both rows found an improvement.

No difference

Improved

Each block is one evidence row, sized by how many people it enrolled, with its grade inside.

From the rows

The best-graded row, grade B, is a meta-analysis of 115,559 people (2024) and found an improvement.

The rows run from 20,702 to 115,559 people, published from 2015 to 2024: 1 pooled review and 1 single study.

2 improved

Grade BStroke risk across folic acid trials · Improved
Meta-analysis, 21 studies · n 115,559 · 2024 · 21 randomized trials worldwide
Varied across trials · Varied across trials
Stroke risk was 10% lower with folic acid (RR 0.90; 95% CI 0.83 to 0.98). The benefit was seen where grain is not or only partly fortified (RR 0.83) but not where it is fortified (RR 1.04), and was largest in people without a previous stroke or heart attack (RR 0.77).
Row on the Folate (methylfolate vs folic acid) page · PubMed 38824900 (opens PubMed)
Grade BFirst stroke in adults with high blood pressure (CSPPT) · Improved
RCT · n 20,702 · 2015 · Adults with hypertension and no history of stroke or heart attack in China
0.8 mg/day folic acid (with enalapril 10 mg) · Median 4.5 years
First stroke occurred in 2.7% vs 3.4% (HR 0.79; 95% CI 0.68-0.93). Heart attack and all-cause death did not differ.
Row on the Folate (methylfolate vs folic acid) page · PubMed 25771069 (opens PubMed)