Vitamin B12 deficiency and hyperhomocysteinaemia in outpatients with stroke or transient ischaemic attack: a cohort study at an academic medical centre. Issue 1 (21st January 2019)

• Record Type: Journal Article
• Authors: Ahmed, Shamon; Bogiatzi, Chrysi; Hackam, Daniel G; Rutledge, Angela C; Sposato, Luciano A; Khaw, Alexander; Mandzia, Jennifer; Azarpazhoo, Mahmoud Reza; Hachinski, Vladimir; Spence, J David
• Is Part Of: BMJ open. Volume 9:Issue 1(2019)
• Publication Date: 2019-01-21
• Subjects: stroke -- B12 -- homocysteine; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-026564
• Languages: English
• ISSNs: 2044-6055

Abstract

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 (B12 Def, serum B12 <156 pmol/L), hyperhomocysteinaemia (HHcy; plasma total homocysteine [tHcy] >14 µmol/L) and metabolic B12 deficiency (MetB12 Def, 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. B12 Def 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). MetB12 Def was present in 10.6% of patients, and HHcy was present in 19.1% of patients. Among the patients aged ≥80 years, MetB12 Def 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, B12 Def, MetB12 Def 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.