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To the Editor: Several large prospective observational studies and a recent meta-analysis¹ suggested an association between elevated levels of homocysteine and risk of cardiovascular diseases. A population-based cohort study found that folate supplementation is effective in decreasing total homocysteine concentration.² However, the meta-analysis of randomized controlled trials by Dr Bazzano and colleagues³ did not find any effect of folic acid supplementation on the risk of cardiovascular diseases or all-cause mortality among patients with a prior history of vascular disease.

The authors suggested possible factors that may have contributed to the discrepancy between the results of their meta-analysis and those of observational studies, including the presence of confounding factors in observational studies, the lack of efficacy of folic acid supplementation in secondary prevention, and the beneficial effect of folic acid supplementation only in populations with specific genetic backgrounds or with folate deficiency. However, the inefficacy of folate supplementation in reducing the . . . [Full Text of this Article]

Francesco Dentali, MD
fdentali@libero.it

Monica Gianni, MD; Walter Ageno, MD
Department of Clinical Medicine
Insubria University
Varese, Italy

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