title: B vitamins and magnetic resonance imaging-detected ischemic brain lesions in patients with recent transient ischemic attack or stroke: the VITAmins TO Prevent Stroke (VITATOPS) MRI-substudy.
abstract: OBJECTIVE
  Elevated concentrations of homocysteine are associated with cerebral small vessel disease (CSVD). B-vitamin supplementation with folate and vitamins B12 and B6 reduces homocysteine concentrations. In a substudy of the VITAmins TO Prevent Stroke (VITATOPS) trial, we assessed the hypothesis that the addition of once-daily supplements of B vitamins would reduce the progression of CSVD-related brain lesions.
  
  
  METHODS
  A total of 359 patients with recent stroke or transient ischemic attack, who were randomly allocated to double-blind treatment with placebo or b vitamins, underwent brain MRI at randomization and after 2 years of B-vitamin supplementation. MR images were analyzed blinded to treatment allocation. Outcomes related to the prespecified hypothesis were progression of white matter hyperintensities and incident lacunes. We also explored the effect of B-vitamin supplementation on the incidence of other ischemic abnormalities.
  
  
  RESULTS
  After 2 years of treatment with b vitamins or placebo, there was no significant difference in white matter hyperintensities volume change (0.08 vs 0.13 cm3; P=0.419) and incidence of lacunes (8.0% vs 5.9%, P=0.434; odds ratio=1.38). In a subanalysis of patients with MRI evidence of severe CSVD at baseline, b-vitamin supplementation was associated with a significant reduction in white matter hyperintensities volume change (0.3 vs 1.7 cm3; P=0.039).
  
  
  CONCLUSIONS
  Daily B-vitamin supplementation for 2 years did not significantly reduce the progression of brain lesions resulting from presumed CSVD in all patients with recent stroke or transient ischemic attack but may do so in the subgroup of patients with recent stroke or transient ischemic attack and severe CSVD.
  
  
  BACKGROUND
  http://vitatops.highway1.com.au/. Unique identifier: NCT00097669 and ISRCTN74743444.
authors.affiliation: Medical University of Graz, Department of Neurology, Division of Neurogeriatrics, Auenbruggerplatz 22, 8036 Graz, Austria.
authors.forename: Margherita
authors.initials: M
authors.lastname: Cavalieri
authors.forename: Reinhold
authors.initials: R
authors.lastname: Schmidt
authors.forename: Christopher
authors.initials: C
authors.lastname: Chen
authors.forename: Vincent
authors.initials: V
authors.lastname: Mok
authors.forename: Gabriel R
authors.initials: GR
authors.lastname: de Freitas
authors.forename: Swithin
authors.initials: S
authors.lastname: Song
authors.forename: Qilong
authors.initials: Q
authors.lastname: Yi
authors.forename: Stefan
authors.initials: S
authors.lastname: Ropele
authors.forename: Anja
authors.initials: A
authors.lastname: Grazer
authors.forename: Nina
authors.initials: N
authors.lastname: Homayoon
authors.forename: Christian
authors.initials: C
authors.lastname: Enzinger
authors.forename: Katherine
authors.initials: K
authors.lastname: Loh
authors.forename: Ka Sing Lawrence
authors.initials: KS
authors.lastname: Wong
authors.forename: Adrian
authors.initials: A
authors.lastname: Wong
authors.forename: Yunyun
authors.initials: Y
authors.lastname: Xiong
authors.forename: Hui Meng
authors.initials: HM
authors.lastname: Chang
authors.forename: Meng Cheong
authors.initials: MC
authors.lastname: Wong
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
authors.forename: John W
authors.initials: JW
authors.lastname: Eikelboom
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control*; D056784:Leukoencephalopathies / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010919:Placebos; D059409:Stroke, Lacunar / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control*; D017211:Treatment Failure; D014805:Vitamin B 12 / Q000008:administration & dosage; D025101:Vitamin B 6 / Q000008:administration & dosage; D014803:Vitamin B Complex / Q000008:administration & dosage*
chemical_list: D010919:Placebos; D014803:Vitamin B Complex; D025101:Vitamin B 6; D005492:Folic Acid; D014805:Vitamin B 12