Treatment With B Vitamins and Incidence of Cancer in Patients With Previous Stroke or Transient Ischemic Attack Results of a Randomized Placebo-Controlled Trial

被引：25

作者：

Hankey, Graeme J. ^{[1
]}

Eikelboom, John W. ^{[2
]}

Yi, Qilong ^{[3
]}

Lees, Kennedy R. ^{[4
]}

Chen, Christopher ^{[5
]}

Xavier, Denis ^{[6
]}

Navarro, Jose C. ^{[7
]}

Ranawaka, Udaya K. ^{[8
]}

Uddin, Wasim ^{[9
]}

Ricci, Stefano ^{[10
]}

Gommans, John ^{[11
]}

Schmidt, Reinhold ^{[12
]}

机构：

[1] Royal Perth Hosp, Dept Neurol, Perth, WA 6001, Australia

[2] McMaster Univ, Dept Med, Hamilton, ON, Canada

[3] Canadian Blood Serv, Natl Epidemiol & Surveillance, Ottawa, ON, Canada

[4] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland

[5] Natl Univ Singapore, Dept Pharmacol, Singapore 117548, Singapore

[6] St Johns Med Coll & Res Inst, Dept Pharmacol & Clin Trials, Bangalore, Karnataka, India

[7] Jose R Reyes Mem Med Ctr, Manila, Philippines

[8] Univ Kelaniya, Fac Med, Ragama, Sri Lanka

[9] POF Hosp, Dept Med, Wah Cantt, Pakistan

[10] ASL 1 Umbria, UO Neurol, Perugia, Italy

[11] Hawkes Bay Hosp, Hastings, New Zealand

[12] Med Univ Graz, Dept Neurol, Graz, Austria

来源：

STROKE | 2012年 / 43卷 / 06期

基金：

英国医学研究理事会;

关键词：

prevention; randomized controlled trials; FOLIC-ACID FORTIFICATION; COLORECTAL-CANCER; FOLATE; PREVENTION; RISK; POLYMORPHISMS; METABOLISM; MORTALITY; ADENOMAS; VITATOPS;

D O I：

10.1161/STROKEAHA.111.641613

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-To determine the effect of B vitamin treatment on the incidence of cancer among patients with stroke or transient ischemic attack. Methods-A total of 8164 patients with recent stroke or transient ischemic attack were randomly allocated to double-blind treatment with 1 tablet daily of placebo or B vitamins (2 mg folic acid, 25 mg vitamin B-6, 500 mu g vitamin B-12) and followed for a median of 3.4 years for any cancer as an adverse event. Results-There was no significant difference in the incidence of any cancer among participants assigned B vitamins compared with placebo (4.04% versus 4.59%; risk ratio, 0.86; 95% CI, 0.70-1.07) and no difference in cancer mortality (2.35% versus 2.09%; risk ratio, 1.09; 0.81-1.46). Among 1899 patients with diabetes, the incidence of cancer was higher among participants assigned B vitamins compared with placebo (5.35% versus 3.28%; adjusted risk ratio, 2.21; 1.31-3.73), whereas among 6168 patients without diabetes, the incidence of cancer was lower among participants assigned B vitamins compared with placebo (3.66% versus 5.03%; adjusted risk ratio, 0.67; 0.51-0.87; P for interaction=0.0001). Conclusions-Daily administration of folic acid, vitamin B-6, and vitamin B-12 to 8164 patients with recent stroke or transient ischemic attack for a median of 3.4 years had no significant effect, compared with placebo, on cancer incidence or mortality. However, a post hoc subgroup analysis raises the hypothesis that folic acid treatment may increase the incidence of cancer among diabetics and reduce the incidence of cancer among nondiabetics with a history of stroke or transient ischemic attack.

引用

页码：1572 / 1577

页数：6

共 21 条

[1] Effects of Lowering Homocysteine Levels With B Vitamins on Cardiovascular Disease, Cancer, and Cause-Specific Mortality Meta-analysis of 8 Randomized Trials Involving 37 485 Individuals [J].

Clarke, Robert ;

Halsey, Jim ;

Lewington, Sarah ;

Lonn, Eva ;

Armitage, Jane ;

Manson, JoAnn E. ;

Bonaa, Kaare H. ;

Spence, J. David ;

Nygard, Ottar ;

Jamison, Rex ;

Gaziano, J. Michael ;

Guarino, Peter ;

Bennett, Derrick ;

Mir, Fraz ;

Peto, Richard ;

Collins, Rory .

ARCHIVES OF INTERNAL MEDICINE, 2010, 170 (18) :1622-1631

[2] Folic acid for the prevention of colorectal adenomas - A randomized clinical trial [J].

Cole, Bernard F. ;

Baron, John A. ;

Sandler, Robert S. ;

Haile, Robert W. ;

Ahnen, Dennis J. ;

Bresalier, Robert S. ;

McKeown-Eyssen, Gail ;

Summers, Robert W. ;

Rothstein, Richard I. ;

Burke, Carol A. ;

Snover, Dale C. ;

Church, Timothy R. ;

Allen, John I. ;

Robertson, Douglas J. ;

Beck, Gerald J. ;

Bond, John H. ;

Byers, Tim ;

Mandel, Jack S. ;

Mott, Leila A. ;

Pearson, Loretta H. ;

Barry, Elizabeth L. ;

Rees, Judy R. ;

Marcon, Norman ;

Saibil, Fred ;

Ueland, Per Magne ;

Greenberg, E. Robert .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2007, 297 (21) :2351-2359

[3] Cancer Incidence and Mortality After Treatment With Folic Acid and Vitamin B12 [J].

Ebbing, Marta ;

Bonaa, Kaare Harald ;

Nygard, Ottar ;

Arnesen, Egil ;

Ueland, Per Magne ;

Nordrehaug, Jan Erik ;

Rasmussen, Knut ;

Njolstad, Inger ;

Refsum, Helga ;

Nilsen, Dennis W. ;

Tverdal, Aage ;

Meyer, Klaus ;

Vollset, Stein Emil .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2009, 302 (19) :2119-2126

[4] Epidemiologic studies of folate and colorectal neoplasia: a review [J].

Giovannucci, E .

JOURNAL OF NUTRITION, 2002, 132 (08) :2350S-2355S

[5] Diabetes and Cancer A consensus report [J].

Giovannucci, Edward ;

Harlan, David M. ;

Archer, Michael C. ;

Bergenstal, Richard M. ;

Gapstur, Susan M. ;

Habel, Laurel A. ;

Pollak, Michael ;

Regensteiner, Judith G. ;

Yee, Douglas .

DIABETES CARE, 2010, 33 (07) :1674-1685

[6] VITATOPS, the VITAmins TO Prevent Stroke trial: rationale and design of a randomised trial of B-vitamin therapy in patients with recent transient ischaemic attack or stroke (NCT00097669) (ISRCTN74743444) [J].

Hankey, G. J. ;

Baker, R. I. ;

Eikelboom, J. W. ;

Gelavis, A. ;

Hickling, S. C. ;

Jamrozik, K. ;

van Bockxmeer, F. M. ;

Vasikaran, S. ;

Hankey, G. J. ;

Algra, A. ;

Chen, C. ;

Wong, M. C. ;

Cheung, R. ;

Wong, L. ;

Divjak, I. ;

Ferro, J. ;

Gommans, J. ;

Groppa, S. ;

Hill, M. ;

Spence, D. ;

Lees, K. ;

Lisheng, L. ;

Navarro, J. ;

Ranawaka, U. ;

Ricci, S. ;

Schmidt, R. ;

Slivka, A. ;

Tan, K. ;

Tsiskaridze, A. ;

Uddin, W. ;

Vanhooren, G. ;

Xavier, D. ;

Armitage, J. ;

Hobbs, M. ;

Le, M. ;

Sudlow, C. ;

Wheatley, K. ;

Yi, Q. ;

Bulder, M. ;

Eikelboom, J. W. ;

Hankey, G. J. ;

Ho, W. K. ;

Jamrozik, K. ;

Klijn, K. ;

Koedam, E. ;

Langton, P. ;

Nijboer, E. ;

Tuch, P. ;

Pizzi, J. ;

Tang, M. .

INTERNATIONAL JOURNAL OF STROKE, 2007, 2 (02) :144-150

[7] B vitamins in patients with recent transient ischaemic attack or stroke in the VITAmins TO Prevent Stroke (VITATOPS) trial: a randomised, double-blind, parallel, placebo-controlled trial [J].

Hankey, G. J. ;

Eikelboom, J. W. ;

Baker, R. I. ;

Gelavis, A. ;

Hickling, S. C. ;

Jamrozik, K. ;

van Bockxmeer, F. M. ;

Vasikaran, S. ;

Hankey, G. J. ;

Chen, C. ;

Eikelboom, J. W. ;

Lees, K. R. ;

Yi, Q. ;

Hankey, G. J. ;

Algra, A. ;

Chen, C. ;

Wong, M. C. ;

Cheung, R. ;

Wong, L. ;

Divjak, I. ;

Ferro, J. ;

de Freitas, G. ;

Gommans, J. ;

Groppa, S. ;

Hill, M. ;

Spence, J. D. ;

Lees, K. R. ;

Lisheng, L. ;

Navarro, J. ;

Ranawaka, U. ;

Ricci, S. ;

Schmidt, R. ;

Slivka, A. ;

Tan, K. ;

Tsiskaridze, A. ;

Uddin, W. ;

Vanhooren, G. ;

Xavier, D. ;

Armitage, J. ;

Hobbs, M. ;

Le, M. ;

Sudlow, C. ;

Wheatley, K. ;

Yi, Q. ;

Brown, W. ;

Bulder, M. ;

Eikelboom, J. W. ;

Hankey, G. J. ;

Ho, W. K. ;

Jamrozik, K. .

LANCET NEUROLOGY, 2010, 9 (09) :855-865

[8]

Kim Y, 1999, NUTR REV, V57, P314

[9] Will mandatory folic acid fortification prevent or promote cancer? [J].

Kim, YI .

AMERICAN JOURNAL OF CLINICAL NUTRITION, 2004, 80 (05) :1123-1128

[10] Folate and colorectal cancer: An evidence-based critical review [J].

Kim, Young-In .

MOLECULAR NUTRITION & FOOD RESEARCH, 2007, 51 (03) :267-292

← 1 2 3 →