Homocysteine-lowering therapy did not prevent stroke recurrence.

P a t i e n t s 3680 patients who were ≥ 35 years of age (mean age 66 y, 63% men) and had nondisabling ischemic stroke and elevated total homocysteine (tHcy) levels. Exclusion criteria included embolic stroke, other major neurologic illness, life expectancy < 2 years, need for dialysis, and untreated anemia or vitamin B12 deficiency. Follow-up was 92%. I n t e r v e n t i o n Patients were allocated to high (n = 1827) or low (n = 1853) doses of homocysteine-lowering therapy. The high-dose group received a daily multivitamin tablet that included pyridoxine, 25 mg; cobalamin, 0.4 mg; and folic acid, 2.5 mg. The low-dose group received a daily multivitamin tablet that included pyridoxine, 200 μg; cobalamin, 6 μg; and folic acid, 20 μg. All patients received the best available medical and surgical management to prevent recurrent stroke (i.e., risk factor control education and aspirin, 325 mg/d).