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Vitamin B supplementation, homocysteine levels, and the risk of cerebrovascular disease: a meta-analysis.
Neurology 2013; 81(15):1298-307Neur

Abstract

OBJECTIVE

To perform a meta-analysis on the effect of lowering homocysteine levels via B vitamin supplementation on cerebrovascular disease risk.

METHODS

Using clinical trials published before August 2012 to assess stroke events, we used relative risks (RRs) with 95% confidence intervals (95% CIs) to measure the association between B vitamin supplementation and endpoint events using a fixed-effects model and χ(2) tests. We included 14 randomized controlled trials with 54,913 participants in this analysis.

RESULTS

We observed a reduction in overall stroke events resulting from reduction in homocysteine levels following B vitamin supplementation (RR 0.93; 95% CI 0.86-1.00; p = 0.04) but not in subgroups divided according to primary or secondary prevention measures, ischemic vs hemorrhagic stroke, or occurrence of fatal stroke. There were beneficial effects in reducing stroke events in subgroups with ≥3 years follow-up time, and without background of cereal folate fortification or chronic kidney disease (CKD). Some trials that included CKD patients reported decreased glomerular filtration rate with B vitamin supplementation. We conducted detailed subgroup analyses for cyanocobalamin (vitamin B12) but did not find a significant benefit regarding intervention dose of vitamin B12 or baseline blood B12 concentration. Stratified analysis for blood pressure and baseline participant medication use showed benefits with >130 mm Hg systolic blood pressure and lower antiplatelet drug use in reducing stroke risk.

CONCLUSIONS

B vitamin supplementation for homocysteine reduction significantly reduced stroke events, especially in subjects with certain characteristics who received appropriate intervention measures.

Authors+Show Affiliations

From the Department of Neurology (Y.J., S.T., Y.X., C.S., B.S., J.Q., Y.G.), The First Affiliated Hospital of Zhengzhou University; and the Medical College of ZhengZhou University (A.C.), Zhengzhou, Henan, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

24049135

Citation

Ji, Yan, et al. "Vitamin B Supplementation, Homocysteine Levels, and the Risk of Cerebrovascular Disease: a Meta-analysis." Neurology, vol. 81, no. 15, 2013, pp. 1298-307.
Ji Y, Tan S, Xu Y, et al. Vitamin B supplementation, homocysteine levels, and the risk of cerebrovascular disease: a meta-analysis. Neurology. 2013;81(15):1298-307.
Ji, Y., Tan, S., Xu, Y., Chandra, A., Shi, C., Song, B., ... Gao, Y. (2013). Vitamin B supplementation, homocysteine levels, and the risk of cerebrovascular disease: a meta-analysis. Neurology, 81(15), pp. 1298-307. doi:10.1212/WNL.0b013e3182a823cc.
Ji Y, et al. Vitamin B Supplementation, Homocysteine Levels, and the Risk of Cerebrovascular Disease: a Meta-analysis. Neurology. 2013 Oct 8;81(15):1298-307. PubMed PMID: 24049135.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vitamin B supplementation, homocysteine levels, and the risk of cerebrovascular disease: a meta-analysis. AU - Ji,Yan, AU - Tan,Song, AU - Xu,Yuming, AU - Chandra,Avinash, AU - Shi,Changhe, AU - Song,Bo, AU - Qin,Jie, AU - Gao,Yuan, Y1 - 2013/09/18/ PY - 2013/9/20/entrez PY - 2013/9/21/pubmed PY - 2013/12/16/medline SP - 1298 EP - 307 JF - Neurology JO - Neurology VL - 81 IS - 15 N2 - OBJECTIVE: To perform a meta-analysis on the effect of lowering homocysteine levels via B vitamin supplementation on cerebrovascular disease risk. METHODS: Using clinical trials published before August 2012 to assess stroke events, we used relative risks (RRs) with 95% confidence intervals (95% CIs) to measure the association between B vitamin supplementation and endpoint events using a fixed-effects model and χ(2) tests. We included 14 randomized controlled trials with 54,913 participants in this analysis. RESULTS: We observed a reduction in overall stroke events resulting from reduction in homocysteine levels following B vitamin supplementation (RR 0.93; 95% CI 0.86-1.00; p = 0.04) but not in subgroups divided according to primary or secondary prevention measures, ischemic vs hemorrhagic stroke, or occurrence of fatal stroke. There were beneficial effects in reducing stroke events in subgroups with ≥3 years follow-up time, and without background of cereal folate fortification or chronic kidney disease (CKD). Some trials that included CKD patients reported decreased glomerular filtration rate with B vitamin supplementation. We conducted detailed subgroup analyses for cyanocobalamin (vitamin B12) but did not find a significant benefit regarding intervention dose of vitamin B12 or baseline blood B12 concentration. Stratified analysis for blood pressure and baseline participant medication use showed benefits with >130 mm Hg systolic blood pressure and lower antiplatelet drug use in reducing stroke risk. CONCLUSIONS: B vitamin supplementation for homocysteine reduction significantly reduced stroke events, especially in subjects with certain characteristics who received appropriate intervention measures. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/24049135/Vitamin_B_supplementation_homocysteine_levels_and_the_risk_of_cerebrovascular_disease:_a_meta_analysis_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=24049135 DB - PRIME DP - Unbound Medicine ER -