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Management and Prevention of Stroke Associated with Elevated Homocysteine.
MedLine Citation:
PMID:  12194809     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Observational data from prospective and retrospective studies indicate that elevated homocyst(e)ine (Hcy) is associated with preclinical markers of cerebrovascular disease and ischemic stroke. Although the exact mechanisms of this association are unresolved, data indicate that elevated Hcy promotes cerebral, arterial, and venous thrombosis, and may predispose to premature atherosclerosis and craniocervical arterial dissection. Plasma Hcy is a sensitive marker of low folate, B(12), and B(6) status. Data consistently indicate that folic acid supplementation in the form of vitamin tablets is the most effective strategy to lower mild-to-moderately elevated Hcy, with maximal benefit occurring in individuals with higher pretreatment Hcy or lower pretreatment folate levels. B(12) supplementation confers a minor additional benefit, whereas B(6) supplementation has not been demonstrated to confer further benefit. Despite reports that Hcy-lowering therapy may improve surrogate measures of vascular disease, the outcomes of clinical trials for secondary stroke prevention are pending. Until this information is available, we concur with the American Stroke Association guidelines for stroke prevention. Specifically, we recommend good dietary intake of foods rich in folic acid, B(6), and B(12) for primary prevention, and supplemental multivitamins (folic acid 400 g to 1 mg daily, B(12) 400 to 600 g daily, B(6) 2 to 10 mg daily) for individuals with known cerebrovascular disease and hyper-Hcy.
Authors:
Peter J. Kelly; Karen L. Furie
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Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Current treatment options in cardiovascular medicine     Volume:  4     ISSN:  1534-3189     ISO Abbreviation:  Curr Treat Options Cardiovasc Med     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-Aug-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815942     Medline TA:  Curr Treat Options Cardiovasc Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  363-371     Citation Subset:  -    
Affiliation:
Stroke Service, Department of Neurology, VBK 802, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. pjkelly@partners.org
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