TY - JOUR
T1 - Differential effect of B-vitamin therapy by antiplatelet use on risk of recurrent vascular events after stroke
AU - Arshi, Baback
AU - Ovbiagele, Bruce
AU - Markovic, Daniela
AU - Saposnik, Gustavo
AU - Towfighi, Amytis
N1 - Publisher Copyright:
© 2015 American Heart Association, Inc.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Background and Purpose: Although several randomized controlled trials failed to show a benefit of B vitamin therapy on composite outcomes of cardiovascular death, myocardial infarction, and stroke among individuals with elevated homocysteine, recent post hoc analyses have suggested that several factors may interact with the effects of vitamin treatment. One post hoc analysis revealed an interaction between B vitamin therapy and antiplatelet use; however, those results have not been replicated in other studies or populations. Methods: We conducted a post hoc analysis of the Vitamin Intervention for Stroke Prevention (VISP) trial, a randomized controlled trial evaluating treatment with high-versus low-dose B vitamin therapy for secondary prevention of vascular events among stroke survivors with elevated homocysteine. Cox regression models were used to assess primary (recurrent stroke) and secondary (stroke, myocardial infarction, or vascular death) outcomes among individuals on high-versus lowdose vitamin therapy, categorized by antiplatelet use, after adjusting for covariates. Results: Among 3680 participants, 52% took antiplatelet medications. When compared with low-dose therapy, high-dose vitamin therapy was associated with higher stroke risk among individuals on antiplatelets (hazard ratio, 1.43; 95% confidence interval, 1.02-2.01), but trended toward lower risk among those not on antiplatelets (hazard ratio, 0.86; 95% confidence interval, 0.62-1.19). Conclusions: High-dose B vitamin therapy may be associated with a higher risk of recurrent stroke among stroke survivors taking antiplatelets, but does not have a significant effect on recurrent stroke risk in those who are not on antiplatelets. Future randomized controlled trials may consider evaluating the effect of homocysteine lowering among stroke survivors with elevated homocysteine who are not on antiplatelet therapy.
AB - Background and Purpose: Although several randomized controlled trials failed to show a benefit of B vitamin therapy on composite outcomes of cardiovascular death, myocardial infarction, and stroke among individuals with elevated homocysteine, recent post hoc analyses have suggested that several factors may interact with the effects of vitamin treatment. One post hoc analysis revealed an interaction between B vitamin therapy and antiplatelet use; however, those results have not been replicated in other studies or populations. Methods: We conducted a post hoc analysis of the Vitamin Intervention for Stroke Prevention (VISP) trial, a randomized controlled trial evaluating treatment with high-versus low-dose B vitamin therapy for secondary prevention of vascular events among stroke survivors with elevated homocysteine. Cox regression models were used to assess primary (recurrent stroke) and secondary (stroke, myocardial infarction, or vascular death) outcomes among individuals on high-versus lowdose vitamin therapy, categorized by antiplatelet use, after adjusting for covariates. Results: Among 3680 participants, 52% took antiplatelet medications. When compared with low-dose therapy, high-dose vitamin therapy was associated with higher stroke risk among individuals on antiplatelets (hazard ratio, 1.43; 95% confidence interval, 1.02-2.01), but trended toward lower risk among those not on antiplatelets (hazard ratio, 0.86; 95% confidence interval, 0.62-1.19). Conclusions: High-dose B vitamin therapy may be associated with a higher risk of recurrent stroke among stroke survivors taking antiplatelets, but does not have a significant effect on recurrent stroke risk in those who are not on antiplatelets. Future randomized controlled trials may consider evaluating the effect of homocysteine lowering among stroke survivors with elevated homocysteine who are not on antiplatelet therapy.
KW - Antiplatelet agents
KW - Homocysteine
KW - Myocardial infarction
KW - Stroke
KW - Vitamin B complex
UR - http://www.scopus.com/inward/record.url?scp=84929295296&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.114.006927
DO - 10.1161/STROKEAHA.114.006927
M3 - Article
C2 - 25649801
AN - SCOPUS:84929295296
SN - 0039-2499
VL - 46
SP - 870
EP - 873
JO - Stroke
JF - Stroke
IS - 3
ER -