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To the Editor: The results of the randomized trial of lowering homocysteine with B vitamins in patients with coronary artery disease (CAD) by Dr Ebbing and colleagues¹ deserve comments. Many studies have shown that hyperhomocysteinemia predicts cardiovascular events,² but they have not clarified the shape of this relationship.³

Similar to other studies, the Western Norway B Vitamin Intervention Trial (WENBIT) was based on the hypothesis that the relationship between plasma homocysteine and risk of cardiovascular events is linear over the entire range of plasma homocysteine values. However, more than 90% of the patients had normal plasma homocysteine values and only 9.6% had mild-to-intermediate hyperhomocysteinemia,¹ and it does not seem plausible to expect any benefit from correcting a risk factor that is not present. The relationship of other causal cardiovascular risk factors (such as elevated blood pressure⁴) appears to be exponential, the risk being absent or very low below a . . . [Full Text of this Article]

Gian Paolo Rossi, MD
gianpaolo.rossi@unipd.it

Teresa Maria Seccia, MD, PhD; Achille C. Pessina, MD, PhD
Department of Clinical and Experimental Medicine
University of Padova
Padova, Italy

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