{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T12:56:40Z","timestamp":1775048200013,"version":"3.50.1"},"reference-count":28,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,12,5]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>We sought to assess the current magnitude of the opportunity for secondary stroke prevention with B vitamins.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The Urgent TIA (Transient Ischaemic Attack) Clinic at an academic medical centre.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>We assessed the prevalence of biochemical vitamin B<jats:sub>12<\/jats:sub>deficiency (B<jats:sub>12<\/jats:sub>Def, serum B<jats:sub>12<\/jats:sub>&lt;156\u2009pmol\/L), hyperhomocysteinaemia (HHcy; plasma total homocysteine [tHcy] &gt;14 \u00b5mol\/L) and metabolic B<jats:sub>12<\/jats:sub>deficiency (MetB<jats:sub>12<\/jats:sub>Def, serum B<jats:sub>12<\/jats:sub>&lt;258\u2009pmol\/L and HHcy) between 2002 and 2017, by age group and by stroke subtype.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data were available in 4055 patients. B<jats:sub>12<\/jats:sub>Def was present in 8.2% of patients overall; it declined from 10.9% of patients referred before 2009 to 5.4% thereafter (p=0.0001). MetB<jats:sub>12<\/jats:sub>Def was present in 10.6% of patients, and HHcy was present in 19.1% of patients. Among the patients aged \u226580 years, MetB<jats:sub>12<\/jats:sub>Def was present in 18.1% and HHcy in 35%. Among the 3410 patients whose stroke subtype was determined, HHcy was present in 18.4% of patients: 23.3% of large artery atherosclerosis, 18.1% of cardioembolic, 16.3% of small vessel disease, 10.8% of other unusual aetiologies and 13.6% of undetermined subtypes (p=0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite a decline in our referral area since 2009, B<jats:sub>12<\/jats:sub>Def, MetB<jats:sub>12<\/jats:sub>Def and HHcy remain common in patients with stroke\/TIA. Because these conditions are easily treated and have serious consequences, all patients with stroke\/TIA should have their serum B<jats:sub>12<\/jats:sub>and tHcy measured.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2018-026564","type":"journal-article","created":{"date-parts":[[2019,1,22]],"date-time":"2019-01-22T15:41:46Z","timestamp":1548171706000},"page":"e026564","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":40,"title":["Vitamin B<sub><sub>12<\/sub><\/sub>deficiency and hyperhomocysteinaemia in outpatients with stroke or transient ischaemic attack: a cohort study at an academic medical centre"],"prefix":"10.1136","volume":"9","author":[{"given":"Shamon","family":"Ahmed","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chrysi","family":"Bogiatzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel G","family":"Hackam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela C","family":"Rutledge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luciano A","family":"Sposato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Khaw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Mandzia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmoud Reza","family":"Azarpazhoo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vladimir","family":"Hachinski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7478-1098","authenticated-orcid":false,"given":"J David","family":"Spence","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,1,21]]},"reference":[{"key":"2024052011242370000_9.1.e026564.1","unstructured":"Wood S . 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