Effect of renal function and dose of cyanocobalamin on stroke reduction by B vitamins
| Trial | Dose of cyanocobalamin (μg) | Serum creatinine (μmol/L*) B vitamins | Control | Stroke HR (95% CI) | P values |
| VISP† 32 | 400 | 99.9 (55.7) | 97.2 (47.7) | 1.0 (0.8 to 1.3) | 0.80 |
| VITATOPS‡ 33 | 500 | 92.4 (40.3) | 91.4 (34.6) | 0.92 (0.81 to 1.06) | 0.25 |
| DIVINe34 | 1000 | 141.4 (97.2) | 123.8 (79.6) | 6.6 (0.8 to 54.4) | 0.08 |
| SEARCH39 | 1000 | NA | NA | 1.02 (0.86 to 1.21) | NA |
| CSPPT35 | 0 | 65.95 (19.0) | 65.95 (19.0) | 0.79 (0.68 to 0.93) | 0.003 |
| CSPPT35 | 0 | 126.6 (72.7) | 130.6 (68.6) | 0.88 (0.33 to 2.36) | 0.81 |
| eGFR<60§ | |||||
| CSPPT35 | 0 | 64.7 (13.8) | 64.6 (13.6) | 0.79 (0.67 to 0.92) | 0.003 |
| Excluding eGFR<60§ | |||||
| NORVIT36 | 400 | 91 (27) | 91 (24) | 0.83 (0.47 to 1.47) | 0.52 |
| HOPE37 | 1000 | 88.4 (26.5) | 88.4 (26.5) | 0.75 (0.59 to 0.97) | 0.03 |
| SU.Fol.OM338 | 20 | 78.0 (70.0-88.0) | 78.0 (69.0–88.0) | 0.57 (0.33 to 0.97) | 0.04 |
Individual data were obtained from both VISP32 and VITATOPS33 trials. Reproduced with permission from Elsevier.12
*Data are presented as mean (SD), unless otherwise specified.
†Patients with an eGFR of less than 50 mL/min/1.73 m² had a mean eGFR rate (SD) of 38.7 mL/min/1.73 m² (9.2) (control 39.3 mL/min/1.73 m² (8.6); composite outcomes HR (95% CI) 1.01 (0.74 to 1.37; p=0.977)). Patients with an eGFR of 50 mL/min/1.73 m² or more had mean eGFR rate of 89.2 mL/min/1.73 m² (44.6) (control 87.3 (31.1); composite outcomes HR 0.92 (0.77 to 1.11; p=0.382)). Composite outcomes refer to myocardial infarction, stroke or death.
‡Patients with an eGFR of 50 mL/min/1.73 m² or less had a mean eGFR rate (SD) of 38.6 mL/min/1.73 m² (10.0) (control 38.3 (9.5); composite outcomes HR (95% CI) 0.88 (0.59 to 1.32; p=0.54)). Patients with an eGFR of more than 50 mL/min/1.73 m² had a mean eGFR rate of 80.2 (18.1) (control 80.9 (18.3); composite outcomes HR 0.82 (0.68 to 0.98; p=0.03)). Composite outcomes refer to myocardial infarction, stroke or death.
§mL/min/1.73 m².
CSPPT, China Stroke Primary Prevention Trial; eGFR, estimated glomerular filtration rate (mL/min/1.73 m²); NA, not applicable; VISP, Vitamins Intervention for Stroke Prevention; VITATOPS, VITAmins TO Prevent Stroke.
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