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Published on: August 18, 2015

Is plasma homocysteine a modifiable risk factor for stroke?

Graeme J Hankey1

  • 1Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, WA, Australia. gjhankey@cyllene.uwa.edu.au

Nature Clinical Practice. Neurology
|August 26, 2006
PubMed

Insights

High homocysteine levels are linked to stroke risk, but B-vitamin therapy did not significantly reduce stroke in a major trial. More research is needed to confirm if lowering homocysteine prevents stroke.

Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Nutritional Science

Background:

  • Elevated plasma total homocysteine (tHcy) is associated with increased risk of atherothrombotic vascular disease, including ischemic stroke.
  • This association is independent of other vascular risk factors and is biologically plausible.
  • However, randomized controlled trials have not yet confirmed a causal relationship.

Purpose of the Study:

  • To investigate whether lowering plasma total homocysteine (tHcy) levels with B-vitamin therapy reduces the risk of stroke.
  • To evaluate the efficacy of B-vitamin supplementation in preventing recurrent ischemic stroke.

Main Methods:

  • The Vitamins In Stroke Prevention (VISP) trial involved 3,680 patients with recent ischemic stroke.
  • Participants received either B-vitamin therapy or a placebo.
  • Plasma tHcy levels were monitored, and stroke events were recorded.

Main Results:

  • B-vitamin therapy did not result in a statistically significant reduction in the relative risk of stroke.
  • The trial could not reliably exclude a modest but potentially important risk reduction of up to 20% in stroke.
  • No significant effect on stroke prevention was observed with homocysteine lowering therapy.

Conclusions:

  • There is currently insufficient evidence to establish homocysteine as a modifiable causal risk factor for stroke.
  • Routine screening for, or treatment of, elevated tHcy concentrations with folic acid and other vitamins is not recommended for stroke prevention based on current data.

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