Post-Stent Care: Can B Vitamins and Iron Supplements Be Safe?

Questions regarding anticoagulant medications and supplements after stent placement, thank you?

Dear Dr.
Wu,
I would like to inquire whether it is safe for my mother to take a B-complex vitamin along with iron as a dietary supplement after her coronary artery stenting procedure, or if it would be better to purchase a single B vitamin to avoid potential interactions.

Background: My mother, who is 57 years old, underwent a procedure in 2017 to place three drug-eluting stents due to coronary artery calcification.
Her follow-up reports have been satisfactory.
Recently, she has been experiencing occasional weakness and soreness in her legs, as well as cramping in the soles of her feet.
I have also noticed that her toenails have developed a spoon shape.
After consulting with a physician, she was referred to an orthopedic specialist, who prescribed muscle relaxants, anti-inflammatory medication, and gastric medication.
She takes these medications during episodes of discomfort.
Upon researching online, I found some articles suggesting that she may be deficient in B vitamins.
Therefore, I considered purchasing a B-complex supplement for her.
However, I also came across information indicating that B6, B12, and folic acid might increase the risk of restenosis, which makes me hesitant to proceed.
I suspect that my mother may have symptoms of anemia, which is why I am leaning towards a B-complex plus iron supplement.

Before we can conduct further blood tests when the pandemic stabilizes, is it advisable for her to use this type of supplement? Or would it be safer to only purchase a supplement containing B1?
Thank you for your time and response.
Currently, my mother is taking the following medications: one tablet of Berkey daily, one tablet of Vitor every two days, and half a tablet of Maiyou daily.
For various reasons, she is only eating two meals a day, and for dinner, she consumes rice wine in a glass not exceeding 143 cc (I apologize for this; I know it is not ideal, and I am trying to communicate with her about it, as she has been having trouble sleeping at night).
I understand that alcohol can lead to a deficiency in B1, which is another concern for me.

I have noticed that my mother has lost a significant amount of weight after the stenting procedure and seems to lack sufficient muscle, which worries me, and I am unsure how to address this.

Thank you for your response! The composition of the dietary supplement I am considering includes the following recommended daily amounts:
- B1: 500 mg
- B2: 100 mg
- B3: 30 mg
- B5: 5.5 mg
- B6: 80 mg
- B9: 800 µg
- B12: 50 µg
- B7: 50 µg
- Iron pyrophosphate: 50 mg
- Calcium phosphate: 5 mg

Miss Zhang, 30~39 year old female. Ask Date: 2021/06/20

Dr. Wu Xueming reply Cardiology

The supplementation of vitamins and other nutrients can refer to the daily recommended intake provided by the National Health Administration, and there is no direct relationship between this supplementation and the blockage of coronary artery stents.

Reply Date: 2021/06/20

More Info

Post-stent care is crucial for ensuring the long-term success of the procedure and the overall health of the patient. Your inquiry about the safety of using B vitamins and iron supplements after coronary artery stenting is very relevant, especially considering your mother's medical history and current symptoms.

Firstly, it is essential to understand that vitamin B complex and iron supplements can play a significant role in overall health, particularly in individuals who may be experiencing symptoms of deficiency. The symptoms you described, such as weakness in the legs and spoon-shaped nails, could indicate potential deficiencies in certain nutrients, including B vitamins and iron. Spoon-shaped nails, medically known as koilonychia, can be associated with iron deficiency anemia, which is a condition where the body lacks enough iron to produce hemoglobin, the protein in red blood cells that carries oxygen.

Regarding the use of B vitamins, it is generally safe for most individuals to take B complex vitamins, as they are water-soluble and excess amounts are typically excreted through urine. However, there are specific considerations for patients who have undergone stent placement. Some studies suggest that high doses of certain B vitamins, particularly B6 and B12, may be associated with an increased risk of restenosis (re-narrowing of the artery). Therefore, it is prudent to approach supplementation with caution, especially in the context of your mother's recent stent placement.

Iron supplementation can also be beneficial if your mother is indeed experiencing iron deficiency. However, it is crucial to confirm this through blood tests before starting any supplementation. Excessive iron can lead to toxicity and other health issues, so it should only be taken if a deficiency is confirmed.

Given your mother's current medication regimen, including antiplatelet therapy (which is common after stent placement), it is essential to consult with her healthcare provider before introducing any new supplements. This is to ensure that there are no potential interactions with her current medications and to assess the appropriateness of the dosages in the supplements you are considering.

If you are concerned about the potential interactions and the risk of excessive supplementation, a more targeted approach may be beneficial. Instead of a B complex supplement, you might consider starting with a single B vitamin, such as B1 (thiamine), which is known to be affected by alcohol consumption. Since you mentioned that your mother consumes rice wine, this could indeed contribute to a deficiency in thiamine.
Additionally, it would be wise to have her blood levels checked for B vitamins and iron before starting any new supplements. This way, you can tailor her supplementation to her specific needs based on her blood work results.
In summary, while B vitamins and iron can be beneficial, it is essential to proceed with caution, especially after a stent placement. Consulting with her healthcare provider for personalized advice based on her medical history and current medications is the best course of action. This will help ensure that any supplementation is safe and effective for her health needs.

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