Published Online
on May 8, 2003

A more recent version of this article appeared on June 1, 2003

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Submitted on November 4, 2002
Accepted on December 17, 2002

Low Vitamin B6 but Not Homocyst(e)ine Is Associated With Increased Risk of Stroke and Transient Ischemic Attack in the Era of Folic Acid Grain Fortification

Peter J. Kelly MB, MS, MRCPI^*; Vivian E. Shih MD; J. Philip Kistler MD; Megan Barron BS; Hang Lee PhD; Roseann Mandell BA; and Karen L. Furie MD, MPH

From Stroke Service (P.J.K., J.P.K., M.B., K.L.F.) and Amino Acid Laboratory (V.E.S., R.M.), Department of Neurology, and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston.

^* To whom correspondence should be addressed. E-mail: pjkelly{at}partners.org.

Background and Purpose--The introduction of cereal grain folic acid fortification in 1998 has reduced homocyst(e)ine (tHcy) concentrations in the US population. We performed a case-control study to determine the risk of stroke and transient ischemic attack (TIA) associated with tHcy and low vitamin status in a postfortification US sample.

Methods--Consecutive cases with new ischemic stroke/TIA were compared with matched controls. Fasting tHcy, folate, pyridoxal 5'-phosphate (PLP), B12, and MTHFR 677CT genotype were measured.

Results--Mean PLP was significantly lower in cases than controls (39.97 versus 84.1 nmol/L, P<0.0001). After stroke risk factors were controlled for, a strong independent association was present between stroke/TIA and low PLP (adjusted odds ratio [OR], 4.6; 95% CI, 1.4 to 15.1; P<0.001) but not elevated tHcy (OR, 0.92; 95% CI, 0.4 to 2.1).

Conclusions--Low B6 but not tHcy was strongly associated with cerebrovascular disease in this postfortification, folate-replete sample.

Key words: cerebrovascular disorders • homocyst(e)ine • pyridoxine • risk factors

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