Abstract Details

Title Differential Effect of B-Vitamin Therapy by Antiplatelet Use on Risk of Recurrent Vascular Events after Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S49 - (-)

Poster/Presentation
Number 003

Objective

Background A recent RCT post-hoc analysis suggested that antiplatelets modify vascular protective effects of B-vitamins among stroke/TIA patients with elevated serum HCY. While B-vitamins had no effect on individuals taking antiplatelets, they lowered vascular risk among those not on antiplatelets. We sought to independently confirm these findings.

Design/Methods Post-hoc analysis of the Vitamin Intervention for Stroke Prevention trial, a multicenter, double-blind RCT of high vs. low-dose B-vitamin therapy for lowering HCY among individuals with stroke/TIA. Cox regression models were used, adjusting for sociodemographic and clinical factors, to assess interactions between vitamin dose and antiplatelet therapy on time to (1) stroke and (2) stroke, MI, or vascular death.

Results Among 3,680 participants in VISP, 1,907 were on antiplatelets. For individuals not taking antiplatelets, there was a non-significant pattern of risk reduction for primary and secondary outcomes among those who received high (vs. low)-dose B-vitamins: stroke (HR 0.86, 95% CI 0.62-1.19) and stroke, MI or vascular death (HR 0.90, 95% CI 0.70-1.17). Among individuals taking antiplatelets, those given high-dose B-vitamins had higher likelihood of stroke (HR 1.43, 95% CI 1.02-2.01) as well as stroke, MI or vascular death (HR 1.18, 95% CI 0.90-1.54) than those treated with low-dose B-vitamins.

Conclusions In accord with a recent study, we observed a differential impact of B-vitamin therapy by antiplatelet use on recurrent vascular risk after stroke. While our study also showed a pattern of fewer events among individuals not on antiplatelets who received high-dose B-vitamins, we uniquely noted a detrimental effect of B-vitamin treatment on recurrent stroke risk among those taking antiplatelets. Given the importance of antiplatelet therapy for secondary stroke prevention, the interaction between B-vitamins and antiplatelet use warrants further investigation.

Authors/Disclosures
Baback Arshi, MD PRESENTER	No disclosure on file
Frederik Barkhof, MD, PhD (Image Analysis Center)	Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Frederik Barkhof has received personal compensation in the range of $0-$499 for serving as a Consultant for Biogen. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Combinostics. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for IXICO. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EISAI.
Bruce I. Ovbiagele, MD, MSc, FAAN (San Francisco VA)	Dr. Ovbiagele has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Stroke Association. Dr. Ovbiagele has received research support from National Institutes of Health. Dr. Ovbiagele has a non-compensated relationship as a President with Society for Equity Neuroscience that is relevant to AAN interests or activities. Dr. Ovbiagele has a non-compensated relationship as a Board Member with World Stroke Organization that is relevant to AAN interests or activities.
	No disclosure on file
Gustavo Saposnik, MD (Director, Clinical Outcomes & Decision Neuroscience Research Centre)	Dr. Saposnik has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Saposnik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIHSS. The institution of Dr. Saposnik has received research support from Roche. The institution of Dr. Saposnik has received research support from Heart and Stroke Foundation of Canada.
Amy T. Towfighi, MD	Dr. Towfighi has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law firms. The institution of Dr. Towfighi has received research support from NIH.

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