Gender differences in stroke:
Women developed a higher incidence of stroke than men after the age of 65, women tended to have anterior ischemic strokes more frequently than men, and men were found to have cerebellum or brainstem strokes more often than women (5). Please see recommendations by the US Preventive Services Task Force below on the use of aspirin for prevention of stroke in women.
Importance of homocysteine levels and stroke:
High homocysteine levels are linked with a higher risk of stroke and coronary artery disease and may be lowered using vitamin B6, vitamin B12, and folic acid (6). Preventive Health Advisor supports monitoring and treating high homocysteine levels for prevention of stroke, and in patients with a high homocysteine level and a history of a cerebrovascular event. Using vitamins for lowering homocysteine levels routinely for prevention of coronary artery disease is not adequately supported by research in lowering the risk of heart disease (6). Patients with elevated homocysteine levels of over 18 micromoles per liter (7), may be considered for daily combination regimen of 2.5 mg of folic acid (vitamin B9), 50 mg of vitamin B6 and 1mg of vitamin B12 (8). This regimen is effective for lowering homocysteine (6). Two meta-analyses containing data from many studies found that folic acid was ineffective alone for preventing stroke unless combined with vitamin B12 and vitamin B6 (9,50), and the greatest benefit was seen in patients compliant with the regimen of 3 vitamins for over 3 years (8). Alternatively, patients with elevated homocysteine should seek food sources containing similar amounts to the recommended doses of folic acid, vitamin B6, and vitamin B12 daily from their diet. Of note, vegetarians especially without dairy intake will need to take an oral vitamin B12 supplement. One serving of milk can provide about half of the vitamin B12 daily allowance, but a higher dose of 1 mg daily is required to lower homocysteine. Please see the sections on these vitamins in Preventive Health Advisor to see food sources containing these vitamins. Patients who will likely benefit the most in treatment for an elevated homocysteine level include adults younger than age 69, those with hyperlipidemia, patients from areas where folic acid-fortified food is not available, and patients not currently taking anti-platelet drugs or cholesterol-lowering drugs (8).