How is homocysteinemia treated?

Updated: Jul 27, 2018
  • Author: Pitchaiah Mandava, MD, PhD; Chief Editor: Helmi L Lutsep, MD  more...
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No consensus exists on optimal approaches to the treatment of homocysteinemia.

Plasma homocysteine levels are reduced by folic acid supplementation. With the mandated fortification of cereals with folic acid in the United States, B-12 deficiency (or relative B-12 deficiency) may influence homocysteinemia. The optimal dose and route of administration of B-12 and dose of folic acid and the effect on clinical outcome have not been studied prospectively. Initiation of therapy with B-12, folic acid, and B-6 tends to normalize homocysteine in 4-8 weeks.

The Vitamin Intervention for Stroke Prevention (VISP) trial showed no difference in stroke outcome between high- and low-dose vitamin (B-12, B-6, folic acid) supplementation groups. [11] Subgroup analysis showed that patients with a high baseline homocysteine who were assigned to low-dose vitamins had a higher risk of stroke.

Reanalysis of the Heart Outcomes Prevention Evaluation 2 (HOPE 2) trial showed a reduced incidence of nonfatal stroke with long-term (>3 y) treatment with B vitamins. [12]

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