Vitamins and stroke: the homocysteine hypothesis still in doubt.
During the last years, many epidemiologic studies have identified homocysteine as an independent risk factor for cardiovascular diseases like coronary events, stroke, and venous thromboembolism. Supplementation with oral folate and vitamins B6 and B12 (mainly folate) reduce plasma homocysteine levels to a significant degree. Recent clinical trials showed that vitamin supplementation leads to slower progression or even regression of atherosclerotic lesions in the carotid arteries, as confirmed by ultrasonographic measurement of carotid intima media thickness. However, the recent Vitamin Intervention for Stroke Prevention (VISP) study failed to show any clinical effect on stroke prevention. It is unclear if homocysteine-lowering therapy really has a role in the prevention of cardiovascular diseases. Large trials, which are already conducted, will probably give the definitive answer. In this review, we try to keep pace with the data that make the homocysteine hypothesis still doubtful.
Ntaios
George C
GC
1st Propedeutic Department of Internal Medicine, Aristotle University of Thessalonica, AHEPA Hospital, Salonica, Greece. ntaiosgeorge@yahoo.gr
Savopoulos
Christos G
CG
Chatzinikolaou
Anastasia C
AC
Kaiafa
Georgia D
GD
Hatzitolios
Apostolos
A
D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000378:metabolism / Q000517:prevention & control; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D019587:Dietary Supplements / Q000592:standards / Q000706:statistics & numerical data; D005492:Folic Acid / Q000494:pharmacology* / Q000627:therapeutic use; D006710:Homocysteine / Q000037:antagonists & inhibitors* / Q000097:blood; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000188:drug therapy / Q000378:metabolism / Q000517:prevention & control; D020521:Stroke / Q000188:drug therapy* / Q000378:metabolism / Q000517:prevention & control; D016896:Treatment Outcome; D014805:Vitamin B 12 / Q000494:pharmacology / Q000627:therapeutic use; D025101:Vitamin B 6 / Q000494:pharmacology / Q000627:therapeutic use
D006710:Homocysteine; D025101:Vitamin B 6; D005492:Folic Acid; D014805:Vitamin B 12