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B vitamins for stroke prevention.

Graeme J Hankey1,2

  • 1UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.

Stroke and Vascular Neurology
|July 20, 2018
PubMed
Summary
This summary is machine-generated.

B vitamin supplementation lowers homocysteine and reduces stroke risk, especially in regions without mandatory folic acid fortification. However, higher doses of vitamin B12 with folic acid may negate this benefit.

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Area of Science:

  • Cardiovascular Health
  • Nutritional Neuroscience
  • Preventive Medicine

Background:

  • Elevated total homocysteine (tHcy) is a risk factor for cardiovascular diseases, including stroke.
  • B vitamins, specifically folic acid (vitamin B9), vitamin B12, and vitamin B6, are known to lower tHcy levels.
  • The efficacy of B vitamin supplementation for stroke prevention is debated, particularly concerning folic acid fortification policies.

Purpose of the Study:

  • To evaluate the overall effect of B vitamin supplementation on stroke risk.
  • To investigate factors modifying the relationship between B vitamins and stroke, including folic acid status and vitamin B12 dosage.
  • To compare the effectiveness of B vitamin interventions in countries with and without mandatory folic acid fortification.

Main Methods:

  • Meta-analysis of randomized controlled trials and observational genetic epidemiological studies.
  • Comparison of B vitamin supplementation (folic acid, B12, B6) versus placebo.
  • Stratification of analyses based on folic acid fortification policies, vitamin B12 dosage, and renal function.

Main Results:

  • B vitamin supplementation reduced overall stroke risk by approximately 10% (RR 0.90).
  • No significant effects were observed for myocardial infarction, all-cause mortality, or adverse outcomes.
  • In countries without folic acid fortification, supplementation reduced stroke risk by 15%; this reduction was greater (25%) with folic acid and low-dose B12, but absent with high-dose B12, especially in renal impairment.

Conclusions:

  • B vitamin supplementation, particularly folic acid, can reduce stroke risk, with effectiveness dependent on regional fortification policies and vitamin B12 dosage.
  • High-dose cyanocobalamin in combination with folic acid may attenuate stroke risk reduction, especially in patients with chronic kidney disease.
  • Future research should explore combinations of folic acid with methylcobalamin or hydroxocobalamin for stroke prevention, considering the high prevalence of undiagnosed vitamin B12 deficiency.