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Vitamins and stroke: the homocysteine hypothesis still in doubt

George C Ntaios1, Christos G Savopoulos, Anastasia C Chatzinikolaou

  • 11st Propedeutic Department of Internal Medicine, Aristotle University of Thessalonica, AHEPA Hospital, Salonica, Greece. ntaiosgeorge@yahoo.gr

The Neurologist
|January 16, 2008
PubMed

Insights

Homocysteine is a risk factor for cardiovascular diseases. While folate and B vitamin supplements lower homocysteine, their clinical benefit for preventing stroke and cardiovascular events remains uncertain, pending further large trials.

Area of Science:

  • Cardiovascular epidemiology
  • Nutritional science
  • Clinical trials

Background:

  • Homocysteine is recognized as an independent risk factor for cardiovascular diseases, including coronary events, stroke, and venous thromboembolism.
  • Supplementation with folate and B vitamins (B6, B12) effectively reduces plasma homocysteine levels.

Purpose of the Study:

  • To review the current evidence regarding the role of homocysteine-lowering therapy in cardiovascular disease prevention.
  • To evaluate the conflicting results from clinical trials investigating the efficacy of vitamin supplementation for cardiovascular health.

Main Methods:

  • Review of epidemiologic studies identifying homocysteine as a risk factor.
  • Analysis of clinical trial data on vitamin supplementation and cardiovascular outcomes.
  • Examination of studies measuring carotid intima media thickness to assess atherosclerosis progression.

Main Results:

  • Vitamin supplementation significantly lowers plasma homocysteine levels.
  • Some trials show slower progression or regression of atherosclerotic lesions with vitamin therapy.
  • The Vitamin Intervention for Stroke Prevention (VISP) study did not demonstrate a clinical benefit for stroke prevention.

Conclusions:

  • The clinical utility of homocysteine-lowering therapy for preventing cardiovascular diseases remains uncertain.
  • Conflicting trial results necessitate further large-scale studies to definitively answer the question.
  • The homocysteine hypothesis for cardiovascular disease prevention requires continued investigation and data evaluation.

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