Effect of Vitamin B6, B9, and B12 Supplementation on Homocysteine Level and Cardiovascular Outcomes in Stroke Patients: A Meta-Analysis of Randomized Controlled Trials

Abstract

Globally, stroke is the fifth-most leading cause of mortality and also the third leading cause of disability. This study aimed to assess the effect of vitamin B 6 , B 9 , and B 12 supplementation on homocysteine level, risk of stroke, cardiovascular disorders, and vascular death among stroke participants. An extensive literature search was done through PubMed, Medline, Embase, and Clinical key database from 1 January 2000 to 1 January 2020. Effect of vitamin B (B 6 , B 9 , and B 12 ) supplementation on homocysteine was assessed with a mean difference in both vitamin and placebo groups. Risk ratio (RR) was calculated for determining the risk of stroke, major cardiovascular disorder, and vascular death by using a fixed-effect model. A total of eight trials with 8513 participants were included for the final analysis. Vitamin B supplementation intervention was found to have a significant benefit in reducing homocysteine in stroke patients (mean difference -3.84; p<0.00001). The intervention of vitamin B supplementation showed a significant risk reduction of 11% for combined risk of stroke, myocardial infarction, and vascular death among stroke patients, 13% for stroke and 17% for vascular death, whereas no beneficial effect was seen for cardiovascular disorders. This metaanalysis demonstrated up-to-date evidence on the beneficial effect of vitamin B supplementations in reducing homocysteine and preventing the combined risk of stroke, myocardial infarction, and vascular death among stroke patients.

Lesion location and serum levels of homocysteine are associated with early‐onset post‐stroke depression in acute ischemic stroke

“…Many studies have shown that hyperhomocysteinemia is an independent risk factor for cerebral infarction and atherosclerosis (Ganguly & Alam, 2015; Poddar, 2021; T. Zhang et al., 2020). Vitamin B supplementation therapy including vitamin B6, B12, and folic acid, especially in stroke patients, can effectively reduce HCY levels, thereby reducing the risk and recurrence of ischemic stroke (X. Huang et al., 2017; Kataria et al., 2021; Li et al., 2016; Yuan et al., 2021). The mechanisms underlying the relationship of elevated HCY levels and PSD have not been fully elucidated.…”

“…For these reasons, hyperhomocysteinemia is also considered to be highly associated with ischemic stroke. Meanwhile, some studies have indicated that reducing HCY levels by supplementing vitamin B including vitamin B6, B12, and folic acid can reduce the risk of ischemic stroke (X. Huang et al., 2017; Kataria et al., 2021; Li et al., 2016). Previous studies have reported that elevated serum levels of HCY at admission were associated with PSD at 3 months to 1 year after stroke (Cheng et al., 2018; Li et al., 2017; Pascoe et al., 2012).…”

Clinical Efficacy of High Dose Water-Soluble Vitamins Supplementation on Lipid Profile in Pre-Hypertensive Subjects

“…Hence, elevated cholesterol and triglycerides level for a chronic period leads to increased endothelial permeability and causes accumulation of lipoproteins. Further these lipoproteins are oxidized as a result of increased free radical level [18].…”

Homocysteine and Clinical Outcomes in Intracerebral Hemorrhage Patients: Results from the China Stroke Center Alliance

“…A meta-analysis reported that vitamin B supplementations that reduced Hcy prevented the combined risk of stroke, myocardial infarction, and vascular death among stroke patients. 6 …”

“…A meta-analysis reported that vitamin B supplementations that reduced Hcy prevented the combined risk of stroke, myocardial infarction, and vascular death among stroke patients. 6 However, many of the previous researches have been limited to ischemic stroke, and few published studies are available concerning hemorrhagic stroke. Globally, acute spontaneous intracerebral hemorrhage (ICH) accounts for approximately 25% of all stroke cases.…”