B Vitamins in Stroke Patients: Good, Bad, or Indifferent?

Despite the findings of early studies suggesting that raised plasma concentrations of total homocysteine could play a role in major vascular events, daily administration of folic acid, vitamin B6, and vitamin B12 to help lower total homocysteine in patients with previous stroke or transient ischemic attack (TIA)—although safe—was no more effective than placebo, according to the recently published results of the VITATOPS trial.

In the study, 8,164 patients who had experienced a stroke or TIA in the previous 7 months at 123 medical centers in 20 countries were randomized between November 1998 and December 2008 to receive one table daily of placebo or B vitamins (folic acid 2mg, vitamin B6 25mg, vitamin B12 0.5mg).

After a median follow-up of 3.4 years, 15% of patients in the B vitamins group and 17% in the placebo group reached the primary endpoint, the composite of stroke, myocardial infarction, or vascular death.

Thus, the authors conclude in the September 2010 issue of The Lancet Neurology that their results “do not support the use of B vitamins to prevent recurrent stroke,” adding that the “results of ongoing trials and an individual patient data meta-analysis will add statistical power and precision to present estimates of the effect of B vitamins.”

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