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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Dr Schulman and colleagues¹ examined the effect of 6-month arginine supplementation on the outcome of patients with acute ST-segment elevation myocardial infarction. The premise of the study was that arginine, as a unique precursor for nitric oxide synthesis, would be beneficial in reducing vascular stiffness and other parameters of myocardial function following acute myocardial infarction. The study was stopped prior to enrollment of the targeted number of patients because of lack of cardiovascular efficacy as well as increased mortality in the arginine treatment group. The authors conclude that arginine should not be recommended following acute myocardial infarction. Before accepting this recommendation and dismissing the study premise, several factors need to be considered.

First, the prestudy and poststudy plasma arginine levels suggest poor adherence for ingestion. Arginine levels are highly variable and temporarily reflect intake for a short period. A more accurate measurement for verifying intake would be . . . [Full Text of this Article]

Naji N. Abumrad, MD
Naji.abumrad@vanderbilt.edu
Department of Surgery
Vanderbilt University School of Medicine
Nashville, Tenn

Adrian Barbul, MD
Department of Surgery
Johns Hopkins School of Medicine
Baltimore, Md

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