04.01.04
Indication: Recurrent stroke
Source: JAMA, 2004;291:565-575.
Research: Investigators set out to determine whether high doses of folic acid, pyridoxine (vitamin B6) and cobalamin (vitamin B12) could reduce the risk of recurrent stroke over a two-year period compared with low doses of these vitamins. A double-blind, placebo-controlled study was carried out from September 1996 to May 2003 on 3680 adults with nondisabling cerebral infarction. All participants received best medical and surgical care plus a daily multivitamin containing the U.S. FDA reference daily intakes of other vitamins. Patients were randomly assigned to receive once-daily dosing of the high-dose formulation (n=1827) containing 25 mg of pyridoxine, .4 mg of cobalamin and 2.5 mg of folic acid or the low-dose formulation (n=1853) containing 200 Bg of pyridoxine, 6 Bg of cobalamin and 20 Bg of folic acid.
Results: Mean reduction of total homocysteine was greater in the high-dose group than in the low-dose group, but there was no treatment effect on any endpoint. Researchers concluded that moderate reduction of total homocysteine after nondisabling cerebral infarction had no effect on vascular outcomes during the two years of follow-up. However, the consistent findings of an association of total homocysteine with vascular risk suggests that further exploration of the hypothesis is warranted and longer trials in different populations with elevated total homocysteine may be necessary.
Source: JAMA, 2004;291:565-575.
Research: Investigators set out to determine whether high doses of folic acid, pyridoxine (vitamin B6) and cobalamin (vitamin B12) could reduce the risk of recurrent stroke over a two-year period compared with low doses of these vitamins. A double-blind, placebo-controlled study was carried out from September 1996 to May 2003 on 3680 adults with nondisabling cerebral infarction. All participants received best medical and surgical care plus a daily multivitamin containing the U.S. FDA reference daily intakes of other vitamins. Patients were randomly assigned to receive once-daily dosing of the high-dose formulation (n=1827) containing 25 mg of pyridoxine, .4 mg of cobalamin and 2.5 mg of folic acid or the low-dose formulation (n=1853) containing 200 Bg of pyridoxine, 6 Bg of cobalamin and 20 Bg of folic acid.
Results: Mean reduction of total homocysteine was greater in the high-dose group than in the low-dose group, but there was no treatment effect on any endpoint. Researchers concluded that moderate reduction of total homocysteine after nondisabling cerebral infarction had no effect on vascular outcomes during the two years of follow-up. However, the consistent findings of an association of total homocysteine with vascular risk suggests that further exploration of the hypothesis is warranted and longer trials in different populations with elevated total homocysteine may be necessary.