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.
Author(s): Cavalieri M, Schmidt R, Chen C, Mok V, de Freitas GR, Song S, Yi Q, Ropele S,
Grazer A, Homayoon N, Enzinger C, Loh K, Wong KS, Wong A, Xiong Y, Chang HM, Wong
MC, Fazekas F, Eikelboom JW, Hankey GJ; VITATOPS Trial Study Group.
Affiliation(s): Medical University of Graz, Department of Neurology, Division of Neurogeriatrics,
Auenbruggerplatz 22, 8036 Graz, Austria.
Publication date & source: 2012, Stroke. , 43(12):3266-70
BACKGROUND AND PURPOSE: 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.
CLINICAL TRIAL REGISTRATION: http://vitatops.highway1.com.au/. Unique identifier:
NCT00097669 and ISRCTN74743444.
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