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To the Editor: In their cost-effectiveness analysis of vitamin supplementation to lower homocysteine levels and prevent coronary heart disease, Dr Tice and colleagues¹ did not use data from beyond February 1999. The modeling in Table 1 of their article is actually not needed, since 2 controlled total homocysteine (tHcy)–lowering treatment studies have been conducted in the United States and Canada among patients with coronary artery disease who have been chronically exposed to a background of folic acid–fortified cereal grain flour since 1999.^2-3 These studies show that tHcy-lowering effects are only one third to one half of those listed by Tice et al.

Title et al² studied 75 Canadian patients with stable coronary artery disease and tHcy levels of 9 µmol/L or greater. Subjects were randomly assigned to 1 of 3 groups for 16 weeks of treatment; 2 groups received 5 mg/d of folic acid, with or without 2 g/d of . . . [Full Text of this Article]

RELATED ARTICLE

Cost-effectiveness of Vitamin Therapy to Lower Plasma Homocysteine Levels for the Prevention of Coronary Heart Disease: Effect of Grain Fortification and Beyond
Jeffrey A. Tice, Elizabeth Ross, Pamela G. Coxson, Irwin Rosenberg, Milton C. Weinstein, M. G. Myriam Hunink, Paula A. Goldman, Lawrence Williams, and Lee Goldman
JAMA. 2001;286(8):936-943.
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