Multivitamin users have lower risk of dying from stroke

Tuesday, April 21, 2015. An article published online on March 31, 2015 in the American Heart Association journal Stroke reveals a reduction in stroke deaths among older users of multivitamin supplements.

The current study included 72,180 men and women between the ages of 40 and 79 years upon enrollment in the Japan Collaborative Cohort study, which was designed to evaluate the impact of lifestyle factors on health. Dietary questionnaires administered at the beginning of the study collected information on multivitamin use and other data. Subjects were followed for a median of 19.1 years, during which there were 1,148 deaths from ischemic stroke, 877 deaths caused by hemorrhagic stroke and 62 unspecified stroke deaths.

Thirteen percent of the subjects reported multivitamin use. The adjusted risk of overall stroke mortality among multivitamin users was 13% lower than nonusers and the risk of dying from ischemic stroke was 20% lower. Among the 49.2% of subjects who consumed fruit and vegetables less than three times per day, regular use of a multivitamin was associated with a 33% reduction in overall stroke death compared to a 14% lower risk experienced by casual users. When the risk of ischemic stroke death among those with a low intake of fruit and vegetables was examined, regular multivitamin users had less than half the risk of nonusers.

"From this prospective cohort study, we found that multivitamin use, particularly frequent use, was associated with reduced risk of total and ischemic stroke mortality among Japanese people with lower intake of fruits and vegetables," Jia-Yi Dong and colleagues conclude. "This finding supports a beneficial role of multivitamin use among people with insufficient nutrient intakes."

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Insufficient vitamin D levels associated with poor stroke outcomes

The American Stroke Association's International Stroke Conference 2015 held in Nashville February 11-13, 2015 was the site of a presentation of the finding of a greater risk of severe strokes and worsened health during the months that followed among individuals with poor vitamin D status.

Nils Henninger, MD, and his associates evaluated 25-hydroxyvitamin D levels in 96 stroke patients seen between January 2013 and January 2014 at a U.S. hospital. Among those with low vitamin D levels, defined as less than 30 nanograms per milliliter (ng/mL), there was approximately twice the area of dead tissue observed in both lacunar and nonlacunar strokes in comparison with those whose levels were higher. (Lacunar strokes involve small brain arteries, as opposed to nonlacunar strokes that are caused by carotid disease or clots that have migrated from another part of the body.) Dr Henninger and his associates found that for each 10 ng/mL decline in 25-hydroxyvitamin D there was a reduction of nearly 50% in the chance of healthy recovery within the three months following the event.

"Many of the people we consider at high risk for developing stroke have low vitamin D levels," noted Dr Henninger, who is an assistant professor of neurology and psychiatry at University of Massachusetts Medical School in Worcester. "Understanding the link between stroke severity and vitamin D status will help us determine if we should treat vitamin D deficiency in these high-risk patients."

"It's too early to draw firm conclusions from our small study, and patients should discuss the need for vitamin D supplementation with their physician," he added. "However, the results do provide the impetus for further rigorous investigations into the association of vitamin D status and stroke severity. If our findings are replicated, the next logical step may be to test whether supplementation can protect patients at high risk for stroke."

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Health Concern

Stroke

Warning Signs of Stroke (NSA 2012a):

Sudden numbness or weakness of face or limbs, usually on one side of the body
Sudden confusion or trouble speaking or understanding
Sudden loss of vision
Sudden severe headache with no apparent cause
Sudden trouble walking, dizziness, or loss of balance and coordination
If you experience stroke-like symptoms call 911 without delay, even if it is unclear whether a stroke has occurred.

B-vitamin therapy has been shown to lower homocysteine levels and independently reduce stroke risk (Saposnik 2009). Homocysteine levels can become elevated when serum B12 level are below 400 pmol/L (Spence 2011). Analysis of data on 5522 participants in a large trial to assess the role of B-vitamins in stroke risk reduction (the HOPE-2 trial) demonstrated that treatment with folic acid and vitamins B6 and B12 lowered plasma homocysteine levels and overall stroke incidence. In this study, the incidence of both ischemic and hemorrhagic stroke was lower in the vitamin group compared to the placebo group (Saposnik 2009). A 2012 review of 19 different studies found that B-vitamin supplementation reduces stroke risk by approximately 12% (Huang 2012a). Another 2012 study supported those findings by demonstrating that supplementation with folic acid can reduce stroke incidence by 8% (Huo 2012).

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