B Vitamins and Magnetic Resonance Imaging–Detected Ischemic Brain Lesions in Patients With Recent Transient Ischemic Attack or Stroke
| Autor: | Gabriel R. de Freitas, John W. Eikelboom, Swithin Song, Yunyun Xiong, Vincent Mok, Stefan Ropele, Reinhold Schmidt, Christian Enzinger, Margherita Cavalieri, Qilong Yi, Graeme J. Hankey, Hui Meng Chang, Nina Homayoon, Katherine Loh, Franz Fazekas, Adrian Wong, Ka Sing Lawrence Wong, Meng-Cheong Wong, Christopher Chen, Anja Grazer |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Homocysteine Ischemia Placebo Brain Ischemia law.invention Placebos chemistry.chemical_compound Folic Acid Double-Blind Method Randomized controlled trial Leukoencephalopathies law Internal medicine medicine Humans Treatment Failure Stroke Aged Advanced and Specialized Nursing medicine.diagnostic_test business.industry Magnetic resonance imaging Middle Aged medicine.disease Magnetic Resonance Imaging Vitamin B 6 Hyperintensity Surgery Vitamin B 12 B vitamins chemistry Ischemic Attack Transient Cerebrovascular Circulation Stroke Lacunar Vitamin B Complex Disease Progression Cardiology Female Neurology (clinical) Cardiology and Cardiovascular Medicine business |
| Zdroj: | Stroke. 43:3266-3270 |
| ISSN: | 1524-4628 0039-2499 |
| Popis: | Background and Purpose— Elevated concentrations of homocysteine are associated with cerebral small vessel disease (CSVD). b-vitamin supplementation with folate and vitamins b 12 and b 6 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 0.13cm 3 ; 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 1.7cm 3 ; 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. Clinical Trial Registration— http://vitatops.highway1.com.au/ . Unique identifier: NCT00097669 and ISRCTN74743444. |
| Databáze: | OpenAIRE |
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