scholarly journals B Vitamins for Stroke Prevention

2018 ◽  
Vol 71 (19) ◽  
pp. 2147-2148 ◽  
Author(s):  
J. David Spence ◽  
Vladimir Hachinski
Keyword(s):  
Stroke Prevention ◽  
B Vitamins

Stroke prevention - B vitamins

2010 ◽  
Vol 318 ◽  
pp. 1-5 ◽  
Keyword(s):  
Stroke Prevention ◽  
B Vitamins ◽  
Stroke Incidence ◽  
Significant Atherosclerosis ◽  
Almost All

In a nutshellThe association between elevated Hcy, the B vitamins linked to it, and stroke incidence and severity appears strong.So far, a dozen RCTs, (almost all in patients with significant atherosclerosis), have tried to prevent stroke by reducing Hcy through various combinations of folate, B12and B6. In only one trial did this clearly succeed.

scholarly journals Stroke Prevention

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2255-2262
Author(s):  
J. David Spence
Keyword(s):  
Risk Factors ◽  
Stroke Prevention ◽  
Genetic Research ◽  
Egg Yolk ◽  
B Vitamins ◽  
Intestinal Microbiome ◽  
Plaque Burden ◽  
Black Patients ◽  
Risk Patients ◽  
Total Homocysteine

In 44 years of practicing stroke prevention, I have learned many lessons; in this article, I hope to impart some of them. Three areas of my research are discussed. Controlling resistant hypertension is markedly improved by physiologically individualized therapy based on renin/aldosterone phenotyping; this is particularly important in black patients. Measurement of carotid plaque burden strongly predicts cardiovascular risk and is useful for genetic research and for a process called treating arteries instead of risk factors. Doing so in high-risk patients with asymptomatic carotid stenosis was associated with a >80% reduction in the 2-year risk of stroke and myocardial infarction. It also permitted the identification of extremes of atherosclerosis that are useful for studying both the genetics and the biology of atherosclerosis. Patients with very high plaque burden despite low levels of risk factors have an unexplained phenotype; those with little or no plaque despite high levels of risk factors are protected. Patients with unexplained atherosclerosis have higher plasma levels of toxic metabolites produced by the intestinal microbiome largely from egg yolk, red meat, and protein, and those metabolites are renally excreted. This has important dietary implications for stroke prevention. Lowering of plasma total homocysteine with B vitamins significantly reduces the risk of stroke. That was not apparent in early studies because harm from cyanocobalamin among participants with renal failure obscured the benefit among those with good renal function. We should be using B vitamins to prevent stroke but should use methylcobalamin or oxocobalamin instead of cyanocobalamin.

scholarly journals B vitamins for stroke prevention

2018 ◽  
Vol 3 (2) ◽  
pp. 51-58 ◽  
Author(s):  
Graeme J Hankey
Keyword(s):  
Clinical Trials ◽  
Folic Acid ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Folic Acid Supplementation ◽  
Adverse Outcomes ◽  
B Vitamins ◽  
Vitamin B ◽  
Folate Supplementation ◽  
Acid Supplementation

Supplementation with B vitamins (vitamin B9(folic acid), vitamin B12 and vitamin B6) lowers blood total homocysteine (tHcy) concentrations by about 25% and reduces the relative risk of stroke overall by about 10% (risk ratio (RR) 0.90, 95% CI 0.82 to 0.99) compared with placebo. Homocysteine-lowering interventions have no significant effect on myocardial infarction, death from any cause or adverse outcomes. Factors that appear to modify the effect of B vitamins on stroke risk include low folic acid status, high tHcy, high cyanocobalamin dose in patients with impaired renal function and concurrent antiplatelet therapy. In regions with increasing levels or established policies of population folate supplementation, evidence from observational genetic epidemiological studies and randomised controlled clinical trials is concordant in suggesting an absence of benefit from lowering of homocysteine with folic acid for prevention of stroke. Clinical trials indicate that in countries which mandate folic acid fortification of food, folic acid supplementation has no significant effect on reducing stroke risk (RR 1.05, 95% CI 0.90 to 1.23). However, in countries without mandatory folic acid food fortification, folic acid supplementation reduces the risk of stroke by about 15% (RR 0.85, 95% CI 0.77 to 0.94). Folic acid alone or in combination with minimal cyanocobalamin (≤0.05 mg/day) is associated with an even greater reduction in risk of future stroke by 25% (RR 0.75, 95% CI 0.66 to 0.86), whereas the combination of folic acid and a higher dose of cyanocobalamin (≥0.4 mg/day) is not associated with a reduced risk of future stroke (RR 0.95, 95% CI 0.86 to 1.05). The lack of benefit of folic acid plus higher doses of cyanocobalamin (≥0.4 mg/day) was observed in trials which all included participants with chronic kidney disease. Because metabolic B12 deficiency is very common and usually not diagnosed, future randomised trials of homocysteine-lowering interventions for stroke prevention should probably test a combination of folic acid and methylcobalamin or hydroxocobalamin instead of cyanocobalamin, and perhaps vitamin B6.

scholarly journals Efficacy of Supplementation with B Vitamins for Stroke Prevention: A Network Meta-Analysis of Randomized Controlled Trials

PLoS ONE ◽  
2015 ◽  
Vol 10 (9) ◽  
pp. e0137533 ◽  
Author(s):  
Hongli Dong ◽  
Fuhua Pi ◽  
Zan Ding ◽  
Wei Chen ◽  
Shaojie Pang ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Stroke Prevention ◽  
Meta Analysis ◽  
B Vitamins ◽  
Controlled Trials ◽  
Randomized Controlled

B vitamins in stroke prevention: time to reconsider

2017 ◽  
Vol 16 (9) ◽  
pp. 750-760 ◽  
Author(s):  
J David Spence ◽  
Qilong Yi ◽  
Graeme J Hankey
Keyword(s):  
Stroke Prevention ◽  
B Vitamins

scholarly journals Advances in Stroke Prevention

2018 ◽  
Vol 6 (3) ◽  
pp. 105-114 ◽  
Author(s):  
J. David Spence
Keyword(s):  
Blood Pressure ◽  
Carotid Stenosis ◽  
Blood Pressure Control ◽  
Stroke Prevention ◽  
Patent Foramen Ovale ◽  
Pressure Control ◽  
B Vitamins ◽  
Foramen Ovale ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid

Abstract There have been recent advances in stroke prevention in nutrition, blood pressure control, antiplatelet therapy, anticoagulation, identification of high-risk asymptomatic carotid stenosis, and percutaneous closure of patent foramen ovale. There is evidence that the Mediterranean diet significantly reduces the risk of stroke and that B vitamins lower homocysteine, thus preventing stroke. The benefit of B vitamins to lower homocysteine was masked by harm from cyanocobalamin among study participants with impaired renal function; we should be using methylcobalamin instead of cyanocobalamin. Blood pressure control can be markedly improved by individualized therapy based on phenotyping by plasma renin and aldosterone. Loss of function mutations of CYP2D19 impair activation of clopidogrel and limits its efficacy; ticagrelor can avoid this problem. New oral anticoagulants that are not significantly more likely than aspirin to cause severe bleeding, and prolonged monitoring for atrial fibrillation (AF), have revolutionized the prevention of cardioembolic stroke. Most patients (~90%) with asymptomatic carotid stenosis are better treated with intensive medical therapy; the few that could benefit from stenting or endarterectomy can be identified by a number of approaches, the best validated of which is transcranial Doppler (TCD) embolus detection. Percutaneous closure of patent foramen ovale has been shown to be efficacious but should only be implemented in selected patients; they can be identified by clinical clues to paradoxical embolism and by TCD estimation of shunt grade. “Treating arteries instead of treating risk factors,” and recent findings related to the intestinal microbiome and atherosclerosis point the way to promising advances in future.

scholarly journals Stroke Prevention in Older Adults

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3770-3777
Author(s):  
J. David Spence ◽  
M. Reza Azarpazhooh ◽  
Susanna C. Larsson ◽  
Chrysi Bogiatzi ◽  
Graeme J. Hankey
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Carotid Stenosis ◽  
Stroke Prevention ◽  
B Vitamins ◽  
Intestinal Microbiome ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Old Patients ◽  
Lowering Therapy

The risks of stroke and dementia increase steeply with age, and both are preventable. At present, the best way to preserve cognitive function is to prevent stroke. Therapeutic nihilism based on age is common and unwarranted. We address recent advances in stroke prevention that could contribute greatly to prevention of stroke and dementia at a time when the aging of the population threatens to markedly increase the incidence of both. Issues discussed: (1) old patients benefit even more from lipid-lowering therapy than do younger patients; (2) patients with stiff arteries are at risk from a target systolic blood pressure <120 mm Hg; (3) the interaction of the intestinal microbiome, age, and renal function has important dietary implications for older adults; (4) anticoagulation with direct-acting oral anticoagulants should be prescribed more to old patients with atrial fibrillation; (5) B vitamins to lower homocysteine prevent stroke; and (6) most old patients in whom intervention is warranted for carotid stenosis would benefit more from endarterectomy than from stenting. An 80-year-old person has much to lose from a stroke and should not have effective therapy withheld on account of age. Lipid-lowering therapy, a more plant-based diet, appropriate anticoagulation or antiplatelet therapy, appropriate blood pressure control, B vitamins to lower homocysteine, and judicious intervention for carotid stenosis could do much to reduce the growing burden of stroke and dementia.

The role of B vitamins in stroke prevention

2021 ◽  
pp. 1-14
Author(s):  
Geir Bjørklund ◽  
Massimiliano Peana ◽  
Maryam Dadar ◽  
Iryna Lozynska ◽  
Salvatore Chirumbolo ◽  
...  
Keyword(s):  
Stroke Prevention ◽  
B Vitamins
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