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(Stroke. 2006;37:282.)
© 2006 American Heart Association, Inc.

Editorials

Homocysteine

Call Off the Funeral

J. David Spence, MD, FRCPC, FAHA

From the Stroke Prevention and Atherosclerosis Research Centre, London, ON, Canada.

Correspondence to Dr David Spence, Stroke Prevention and Atherosclerosis Research Centre, 1400 Western Rd, London, ON, Canada N6G 2V2. E-mail dspence@robarts.ca

Key Words: hyperhomocysteinemia

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The authors of the much publicized though not yet published Norwegian Vitamin Study (NORVIT)¹ of vitamin therapy in coronary artery disease, are widely quoted as saying that vitamin therapy for lowering plasma total homocysteine (tHcy) was harmful, and that "homocysteine is dead." However, the slides of their presentation¹ do not show the B₁₂ status of the participants, nor do they indicate whether B₁₂ injections were given to participants with low levels of B₁₂. Commentators² have called NORVIT "the largest trial to date to test the hypothesis that folate supplementation reduces risk of cardiovascular disease," but because there were 4 treatment arms in NORVIT, each with 900 participants, the number of patients randomized to folate/B₁₂ or folate/B₁₂/B₆ was essentially the same as that in the Vitamin Intervention for Stroke Prevention (VISP) trial³ (1800). They used a much higher dose of B₆ than other studies and cannot exclude the possibility that their results were driven by that choice. As did VISP, they also used a dose of B₁₂ that, as has recently become apparent, was too low for adequate absorption of B₁₂ in elderly subjects (discussed below).

In this issue of Stroke, a substudy of the Vitamins to Prevent Stroke (VITATOPS) trial⁴ reports that in Singapore, treatment with 2.5 mg folic acid, 0.5 mg vitamin B₁₂, and 25 mg B₆ reduced levels of tHcy by 3.8 µmol/L compared with placebo.⁵ The authors also studied 2 polymorphism of methylene tetrahydrofolate reductase (MTHFR) and found that the MTHFR C677T . . . [Full Text of this Article]

Related Article:

Methylenetetrahydrofolate Reductase Polymorphisms and Homocysteine-Lowering Effect of Vitamin Therapy in Singaporean Stroke Patients

Grace Y.-H. Ho, John W. Eikelboom, Graeme J. Hankey, Chen-Ru Wong, Siew-Li Tan, Jesscia B.-C. Chan, and Christopher P.L.-H. Chen
Stroke 2006 37: 456-460. [Abstract] [Full Text] [PDF]

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				K. M. Wilson, R. B. McCaw, L. Leo, E. Arning, S. Lhotak, T. Bottiglieri, R. C. Austin, and S. R. Lentz Prothrombotic Effects of Hyperhomocysteinemia and Hypercholesterolemia in ApoE-Deficient Mice Arterioscler Thromb Vasc Biol, January 1, 2007; 27(1): 233 - 240. [Abstract] [Full Text] [PDF]