◇Homocysteine-lowering therapy a role in stroke prevention.pdfVIP

Personal View Homocysteine-lowering therapy: a role in stroke prevention? J David Spence Lancet Neurol 2007; 6: 830–38 On the basis of the results of several recent clinical trials, many researchers have concluded that vitamin therapy See Refl ection and Reaction designed to lower total homocysteine concentrations is not eff ective in reducing the risk of cardiovascular events. page 751 However, whereas almost all myocardial infarctions are due to plaque rupture, stroke has many more pathophysiological Stroke Prevention and mechanisms, and thrombosis—which is increased by raised total homocysteine concentrations—has an important Atherosclerosis Research role in many of these processes. Thus, stroke and myocardial infarction could respond diff erently to vitamin therapy. Centre, Robarts Research Institute, London, ON, Canada A detailed assessment of the results of the recent HOPE-2 trial and a reanalysis of the VISP trial restricted to patients (J D Spence MD) capable of responding to vitamin therapy suggest that higher doses of vitamin B12 and perhaps new approaches to Correspondence to: lowering total homocysteine besides routine vitamin therapy with folate, vitamin B6, and vitamin B12 could reduce the J David Spence, Stroke Prevention risk of stroke. Thus, therapy to lower homocysteine could still help to prevent stroke, if not other vascular outcomes. and Atherosclerosis Research Centre, Robarts Research Institute, 1400 Western Road, Introduction Here, I summarise and assess pathophysiological, London, ON, Canada N6G 2V2 Unravelling the risk factors for stroke remains an genetic, and clinical evidence that homocysteine is