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To the Editor: Despite the negative outcomes of the Women's Antioxidant and Folic Acid Cardiovascular Study (WAFACS) by Dr Albert and colleagues¹ and the VISP, HOPE-2, NORVIT, CHAOS-2, and WENBIT trials,² we believe that the homocysteine hypothesis is by no means dead. Although pharmacological intervention with B vitamin supplementation does not seem to provide beneficial cardiovascular outcomes, nutritional intervention with fortification of cereal grains with folic acid may have a significant long-term effect on primary cardiovascular prevention.

Hyperhomocysteinemia does not appear to be as important as other cardiovascular risk factors, such as smoking, dyslipidemia, diabetes mellitus, and hypertension, associated with only a small share of the atherosclerotic process.³ Hence, administration of homocysteine-lowering B vitamin supplements to modify this minor risk factor may require a long period to demonstrate clinical benefits—probably longer than 7.3 years, which was the follow-up duration of the WAFACS trial.¹ Adding 1 more pill to a treatment . . . [Full Text of this Article]

George Ntaios, MD
ntaiosgeorge@yahoo.gr

Christos Savopoulos, MD; Dimitrios Karamitsos, MD
First Propeudeutic Department of Internal Medicine
AHEPA Hospital
Thessaloniki, Greece

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