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(Stroke. 2006;37:547.)
© 2006 American Heart Association, Inc.

Research Reports

Efficacy of B Vitamins in Lowering Homocysteine in Older Men

Maximal Effects for Those With B₁₂ Deficiency and Hyperhomocysteinemia

Leon Flicker, PhD, FRACP; Samuel D. Vasikaran, MD, FRCPA; Jenny Thomas, RN; John M. Acres, Psych; Paul Norman, DS, FRACS; Konrad Jamrozik, DPhil, FAFPHM; Graeme J. Hankey, MD, FRACP Osvaldo P. Almeida, PhD, FRANZCP

From the Department of Core Clinical Pathology and Biochemistry (S.D.V.) and Stroke Unit (G.H.), Royal Perth Hospital, Perth; Schools of Medicine and Pharmacology (L.F., J.T., J.M.A., G.H.), Psychiatry and Clinical Neurosciences (J.M.A., O.P.A.), and Surgery and Pathology (P.N.), University of Western Australia, Perth; School of Population Health (K.J.), University of Queensland, Brisbane, Queensland, Australia.

Correspondence to Leon Flicker, PhD, FRACP, Department of Geriatric Medicine, Royal Perth Hospital, Box X2213 GPO, Perth, Western Australia 6001, Australia. E-mail leonflic{at}cyllene.uwa.edu.au

Background and Purpose— A higher plasma concentration of total homocysteine (tHcy) is associated with a greater risk of cardiovascular events. Previous studies, largely in younger individuals, have shown that B vitamins lowered tHcy by substantial amounts and that this effect is greater in people with higher tHcy and lower folate levels.

Methods— We undertook a 2-year, double-blind, placebo-controlled, randomized trial in 299 men aged 75 years, comparing treatment with a daily tablet containing 2 mg of folate, 25 mg of B₆, and 400 µg of B₁₂ or placebo. The study groups were balanced regarding age (mean±SD, 78.9±2.8 years), B vitamins, and tHcy at baseline.

Results— Among the 13% with B₁₂ deficiency, the difference in mean changes in treatment and control groups for tHcy was 6.74 µmol/L (95% CI, 3.94 to 9.55 µmol/L) compared with 2.88 µmol/L (95% CI, 0.07 to 5.69 µmol/L) for all others. Among the 20% with hyperhomocysteinaemia, the difference between mean changes in treatment and control groups for men with high plasma tHcy compared with the rest of the group was 2.8 µmol/L (95% CI, 0.6 to 4.9 µmol/L). Baseline vitamin B₁₂, serum folate, and tHcy were significantly associated with changes in plasma tHcy at follow-up (r=0.252, r=0.522, and r=–0.903, respectively; P=0.003, <0.001, and <0.001, respectively) in the vitamin group.

Conclusions— The tHcy-lowering effect of B vitamins was maximal in those who had low B₁₂ or high tHcy levels. Community-dwelling older men, who are likely to be deficient in B₁₂ or have hyperhomocysteinemia, may be most likely to benefit from treatment with B vitamins.

Key Words: aged • clinical trial • homocysteine • vitamins • vitamin B₁₂ deficiency

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