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Homocysteine-lowering therapy: a role in stroke prevention?

J David Spence1

  • 1Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, ON, Canada. dspence@robarts.ca

The Lancet. Neurology
|August 21, 2007
PubMed

Insights

Vitamin therapy to lower homocysteine may not prevent heart attacks but could reduce stroke risk. New approaches and higher doses of vitamin B12 show promise for stroke prevention.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Nutritional Science

Background:

  • Previous trials suggest vitamin therapy lowering homocysteine is ineffective for cardiovascular events.
  • Stroke pathogenesis is multifactorial, with thrombosis playing a key role, unlike myocardial infarction which is primarily plaque rupture.
  • Elevated total homocysteine concentrations are linked to increased thrombosis risk.

Purpose of the Study:

  • To investigate if vitamin therapy targeting homocysteine levels can differentially impact stroke versus myocardial infarction risk.
  • To re-evaluate the efficacy of homocysteine-lowering vitamin therapy in preventing vascular events, particularly stroke.

Main Methods:

  • Detailed assessment of the HOPE-2 clinical trial results.
  • Reanalysis of the Vitamin Intervention for Stroke Prevention (VISP) trial, focusing on patients responsive to vitamin therapy.

Main Results:

  • Findings suggest that higher doses of vitamin B12, alongside folate and vitamin B6, may reduce stroke risk.
  • Routine vitamin therapy might not be effective, but specific approaches could still lower homocysteine and prevent stroke.

Conclusions:

  • Homocysteine-lowering therapy may still be a viable strategy for stroke prevention, despite limited efficacy for myocardial infarction.
  • Further research into higher-dose vitamin B12 and novel homocysteine-lowering methods is warranted for vascular event prevention.

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