Vitamin B Therapy, Methionine Synthase and Cystathionine Beta-Synthase (CBS) Gene Polymorphisms, and Their Impact on Homocysteine and Cardiovascular Events in Ischemic Stroke With Normal Renal Function: A Randomized Controlled Trial.

BACKGROUND

Hyperhomocysteinemia cases were found to be higher in hilly regions due to factors such as high altitude and dehydration. There is limited research on methionine synthase (MS) and cystathionine beta-synthase (CBS) gene polymorphisms among stroke patients in Southeast Asia. The primary objective of the study was to determine the efficacy of vitamin B therapy in lowering homocysteine levels, and the secondary objective was to investigate the prevalence and impact of MS and CBS gene polymorphisms on treatment outcomes and cardiovascular events.

METHODS

A randomized controlled trial was conducted on 90 ischemic stroke patients at a tertiary care hospital, Rishikesh, India. Participants received either vitamin B therapy (B6, B9, B12) or standard therapy for four months. Tools were genetic polymorphisms (polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP)) testing, National Institutes of Health Stroke Scale (NIHSS), and modified Rankin Scale (mRS) scores, mean homocysteine, mean vitamin B12, and mean folate levels.

RESULTS

The prevalence of MS-AG and CBS-TT polymorphism frequencies was 6% and 12%, respectively. At four months, the vitamin group showed a significant reduction in homocysteine as 8.6 vs. 19 µmol/L in standard therapy, improved mRS scores, and improved vitamin B12 and folate levels with p < 0.001. Vitamin B12 deficiencies and green vegetable intake were key predictors of hyperhomocysteinemia. Clinical outcomes included one recurrent stroke, eight cardiovascular events, and six vascular deaths.

CONCLUSION

Our observations indicated that vitamin B therapy effectively reduced homocysteine and addressed deficiencies in ischemic stroke patients. However, genetic polymorphism was found to be less prevalent in this hilly region. Combining the role of vitamin B on homocysteine, along with reducing stroke severity and functional disability, leads to early recovery of the stroke patient and reduces rehospitalisation.