Abstract
BACKGROUND: Hyperhomocysteinemia cases were found to be higher in hilly regions due to factors such as high altitude and dehydration. There is limited research on methionine synthase (MS) and cystathionine beta-synthase (CBS) gene polymorphisms among stroke patients in Southeast Asia. The primary objective of the study was to determine the efficacy of vitamin B therapy in lowering homocysteine levels, and the secondary objective was to investigate the prevalence and impact of MS and CBS gene polymorphisms on treatment outcomes and cardiovascular events. METHODS: A randomized controlled trial was conducted on 90 ischemic stroke patients at a tertiary care hospital, Rishikesh, India. Participants received either vitamin B therapy (B6, B9, B12) or standard therapy for four months. Tools were genetic polymorphisms (polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP)) testing, National Institutes of Health Stroke Scale (NIHSS), and modified Rankin Scale (mRS) scores, mean homocysteine, mean vitamin B12, and mean folate levels. RESULTS: The prevalence of MS-AG and CBS-TT polymorphism frequencies was 6% and 12%, respectively. At four months, the vitamin group showed a significant reduction in homocysteine as 8.6 vs. 19 µmol/L in standard therapy, improved mRS scores, and improved vitamin B12 and folate levels with p < 0.001. Vitamin B12 deficiencies and green vegetable intake were key predictors of hyperhomocysteinemia. Clinical outcomes included one recurrent stroke, eight cardiovascular events, and six vascular deaths. CONCLUSION: Our observations indicated that vitamin B therapy effectively reduced homocysteine and addressed deficiencies in ischemic stroke patients. However, genetic polymorphism was found to be less prevalent in this hilly region. Combining the role of vitamin B on homocysteine, along with reducing stroke severity and functional disability, leads to early recovery of the stroke patient and reduces rehospitalisation.