B vitamin intake associated with reductions in homocysteine and risks of stroke and vascular death among stroke patients in clinical trials

A meta-analysis of randomized, controlled trials reported on May 11, 2021 in the journal Cureus revealed lower combined risk of stroke, heart attack and vascular death, as well as a reduction in homocysteine levels, in stroke patients who received B vitamins compared to a placebo.*

Homocysteine is an amino acid formed in the body which, when elevated, is a risk factor for cardiovascular disease and numerous other conditions. Increasing the intake of B vitamins helps lower serum or plasma homocysteine levels by helping it metabolize into downstream products that the body needs.

Researchers at All India Institute of Medical Sciences selected eight trials that included a total of 8,513 stroke patients for their analysis. Trials were limited to those that evaluated homocysteine levels and recurrence of stroke, recurrence of cardiovascular disorders and vascular death (separately or combined) among participants who received a placebo or vitamin B6, vitamin B12 and folate.  

Analysis of the trials’ results found a significant reduction in average homocysteine levels among B-vitamin-intake participants compared to those that received placebo. When the combined risk of heart attack, stroke and vascular death were examined, there was an 11% lower risk among participants who received the vitamins compared to the placebo. Further analysis revealed a 13% lower risk of stroke and a 17% lower risk of vascular death among vitamin B participants.

“This meta-analysis presented substantial evidence proving the beneficial effect of vitamin B [intake], especially among stroke patients, in lowering homocysteine with no documented side effects,” Neetu Kataria and colleagues concluded. “Vitamin B [intake] effectively reduces homocysteine levels and the risk of stroke and vascular deaths.”

“This treatment is highly recommended in clinical settings, which will become a cost-effective strategy for preventing stroke risk, hence relieving the burden of stroke across the globe by reducing homocysteine levels among stroke patients.”

*Kataria N et al. Cureus. 2021 May 11;13(5):e14958.


Apply What You've Learned: Homocysteine

  • Due to the association of elevated serum or plasma homocysteine with a greater risk of cardiovascular disease and other conditions, it is suggested to include homocysteine testing along with your annual routine blood tests.1 If homocysteine levels are elevated, measures can be implemented to lower it, followed by retesting. While a homocysteine test result between 5–14 micromoles per liter is reported as normal, research suggests that having a homocysteine level on the lower end of this range is optimal.2
  • Reducing the intake of foods that are high in methionine, such as red meat, while continuing to maintain a healthy intake of protein may help to maintain homocysteine at a desirable level.3
  • Another way to lower homocysteine is by intake of a B vitamin formula and trimethylglycine (TMG, also known as betaine).4,5 Choline, which is used by the body in the production of TMG, is an additional helpful nutrient and can be found in foods like eggs, dairy and nuts and other sources that provide phosphatidylcholine.6
  • Some other nutrients to consider if homocysteine levels are elevated are N-acetylcysteine (NAC) and taurine.7,8


  1. Refsum H et al. J Nutr. 2006 Jun;136(6 Suppl):1731S-1740S.
  2. Nygard O et al. N Engl J Med. 1997 Jul 24;337(4):230-6.
  3. Kumar A et al. Nutr Metab (Lond). 2017 Dec 22;14:78.
  4. Elbarbary NS et al. Clin Nutr. 2020 Jan;39(1):49-56.
  5. Olthof MR et al. J Nutr. 2003 Dec;133(12):4135-8.
  6. Zeisel SH et al. J Nutr. 2003 May;133(5):1302-7.
  7. Hildebrandt W et al. Am J Clin Nutr. 2015 Nov;102(5):1014-24.
  8. Ahn CS. Adv Exp Med Biol. 2009;643:415-22.

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