Vitamin supplements and new technology can help prevent secondary stroke, researchers claim
A team of researchers argue that vitamin supplements can help prevent secondary strokes. They also advocate for the value of new technologies in eye research to verify these findings.
FAB RESEARCH COMMENT:
Significant reductions in the prevention of stroke in high-risk patients could be achieved by supplementation with particular B vitamins - and existing treatment guidelines from the American Heart and Stroke Associations should be revised to recommend this, according to this new and detailed review of the clinical trial evidence in this area.
People with high blood levels of homocysteine - a toxic by-product of normal metabolism - have elevated risks for heart disease and stroke, as well as age-related cognitive decline, dementia and other neurodegenerative disorders.
To recycle homocysteine and therefore reduce levels, adequate supplies of vitamins B6, B12 and folate (B9) are needed; and numerous clinical trials have shown that supplementing these B vitamins can reduce high homocysteine levels.
Many clinical trials have also shown that dietary supplementation with these B vitamins can help prevent stroke in high-risk populations – although some have found no such benefits, as this new research highlights.
Importantly, these authors point out that negative findings in this area relate to the use of cheaper, synthetic forms of folate or B12 (i.e. folic acid or cyanocobalamin respectively) in patients with renal disease and/or relatively common genetic polymorphisms, for whom these forms are not suitable (but for whom L-methyfolate and methylcobalamin would be safe and appropriate.)
Their analyses show that when these studies are excluded, significant benefits for stroke prevention are evident from B vitamin supplementation to reduce homocysteine in patients who have already had a previous stroke or Transient Ischaemic Attack.
Given the major cost-benefit implications, they call for current US treatment guidelines to be revised accordingly.
The authors also flag new developments in retinal imaging as a useful, non-invasive technique to assess the effectiveness of B vitamin supplementation and homocysteine reduction for cardiovascular and neurological health.
For details of this new research, see:
For more information on the links between B vitamins, homocysteine, brain health and cognition in older adults, please see the following lists of articles, which are frequently updated:
22 November 2023 - University of Maine
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A team of researchers, including one from the University of Maine, argue that vitamin supplements can help prevent secondary strokes. They also advocate for the value of new technologies in eye research to verify these findings.
Homocysteine is an amino acid associated with stroke and secondary stroke when elevated above normal levels.
B vitamins and folate, also known as vitamin B9, can help lower levels of homocysteine and stroke, according to a peer-reviewed editorial published in the journal Pharmacogenomics and Personalized Medicine.
Elevated homocysteine is the result of genetic mutations or inadequate stores of vitamins B6, B12, folate and riboflavin (B2). Lowering it is relatively inexpensive because it can be achieved through vitamin supplementation.
The research team recommends lowering high levels of homocysteine with low doses of folic acid and cyanocobalamin, which treats vitamin B9 and B12 deficiencies, respectively; or better, with the natural vitamin forms found in food, L-methylfolate and methylcobalamin.
Merrill "Pete" Elias, professor emeritus with the UMaine Department of Psychology, Institute of Medicine and Graduate School of Biomedical Sciences and Engineering, co-authored the editorial with colleagues from the University of Arkansas as part of the Maine-Syracuse Longitudinal Study (MSLS), which he directs.
In the editorial, researchers also argued that the 2021 Guideline for the Secondary Prevention of Ischemic Stroke should be revised to include the use of vitamins to reduce homocysteine, specifically folic acid and low dose cyanocobalamin, or better, L-methylfolate and methylcobalamin.
Additionally, the authors urged the use of new ophthalmologic technology for monitoring risk of stroke and secondary stroke.
The research team recommends retinal vascular imaging because this is a noninvasive method for evaluating central nervous system perfusion, which plays a crucial role in stroke.
"The eye is the window to the brain. Thus vascular imaging will play an important role in monitoring the effectiveness of stroke prevention strategies such as the new 2021 Guidelines," Elias says.
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