Effect of B vitamin therapy on prevention of recurrent stroke in ischemic stroke patients with hyperhomocysteinemia / 中华神经科杂志

ABSTRACT

Objective To investigate whether the B vitamins supplements would lower total homocysteine and reduce the risk of recurrent stroke in patients with recent ischemic stroke.Methods A prospective,open,case-controlled clinical trial.One thousand ischcmic stroke patients with hyperhomocysteinemia were followed up.They were assigned to receive either a daily dose of B vitamins (folic acid 2.5 mg,B6 25 mg,B12 500 μg,treatment group,n =500) or not ( control group,n =500) for a period of 2 years.Total homocysteine level,demographic information and traditional risk factors were collected as well as recurrent cerebral infarction were noted.Results Homocysteine levels were significantly reduced in the active treatment group,reduction of total homocysteine was 14.7％ at 3 months and 19.2％ at 24 months ( F =94.39,P ＜0.05 ).The risk of ischemic recurrent stroke with clinical sign within 2 years was 13.6％ for the active treatment group and 14.0％ for the control group ( risk ratio =0.99,95％ CI 0.68—1.42).The risk of recurrent stroke with only MRI or CT brain scan evidence was 4.8％ for both groups (risk ratio =1.11,95％ CI 0.62—2.02 ).The risk of total recurrent stroke was 18.4％ for the treatment group and 18.8％ for the control group ( risk ratio =0.96 ; 95％ CI 0.73—1.26 ),but these effects were not significant.Conclusion A significant benefit of secondary prevention with long-term reductions in blood homocysteine levels with B vitamins supplementationin during the 2 years of follow-up is not yet proven.