Vitamin B 12 deficiency and hyperhomocysteinaemia in outpatients with stroke or transient ischaemic attack: a cohort study at an academic medical centre
Shamon Ahmed, Chrysi Bogiatzi, Daniel G Hackam, Angela C Rutledge, Luciano A Sposato, Alexander Khaw, Jennifer Mandzia, Mahmoud Reza Azarpazhoo, Vladimir Hachinski, J David Spence, Shamon Ahmed, Chrysi Bogiatzi, Daniel G Hackam, Angela C Rutledge, Luciano A Sposato, Alexander Khaw, Jennifer Mandzia, Mahmoud Reza Azarpazhoo, Vladimir Hachinski, J David Spence
Abstract
Objective: We sought to assess the current magnitude of the opportunity for secondary stroke prevention with B vitamins.
Design: A cohort study.
Setting: The Urgent TIA (Transient Ischaemic Attack) Clinic at an academic medical centre.
Main outcome measures: We assessed the prevalence of biochemical vitamin B12 deficiency (B12Def, serum B12 <156 pmol/L), hyperhomocysteinaemia (HHcy; plasma total homocysteine [tHcy] >14 µmol/L) and metabolic B12 deficiency (MetB12Def, serum B12 <258 pmol/L and HHcy) between 2002 and 2017, by age group and by stroke subtype.
Results: Data were available in 4055 patients. B12Def was present in 8.2% of patients overall; it declined from 10.9% of patients referred before 2009 to 5.4% thereafter (p=0.0001). MetB12Def was present in 10.6% of patients, and HHcy was present in 19.1% of patients. Among the patients aged ≥80 years, MetB12Def was present in 18.1% and HHcy in 35%. Among the 3410 patients whose stroke subtype was determined, HHcy was present in 18.4% of patients: 23.3% of large artery atherosclerosis, 18.1% of cardioembolic, 16.3% of small vessel disease, 10.8% of other unusual aetiologies and 13.6% of undetermined subtypes (p=0.0001).
Conclusions: Despite a decline in our referral area since 2009, B12Def, MetB12Def and HHcy remain common in patients with stroke/TIA. Because these conditions are easily treated and have serious consequences, all patients with stroke/TIA should have their serum B12 and tHcy measured.
Keywords: B12; homocysteine; stroke.
Conflict of interest statement
Competing interests: After this paper was written, JDS became a consultant to Orphan Technologies, a company that makes a truncated human cystathionine beta synthase for treatment of classical homocystinuria.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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