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To the Editor: In the WENBIT study, Dr Ebbing and colleagues¹ reported a significant 30% reduction in baseline homocysteine levels (from 10.8 µmol/L to 7.6 µmol/L) in the active treatment group (folic acid and vitamin B₁₂) after 1 year of treatment. However, both mean baseline and final homocysteine levels were within the normal range (<15 µmol/L), meaning that homocysteine was reduced to a lower value from a higher but still normal value.

It is possible that a beneficial effect might have been identified if the study included solely patients with hyperhomocysteinemia. The Homocysteine Lowering Trialists' Collaboration² found that the reduction in homocysteine produced by folic acid supplements was greater at higher pretreatment homocysteine concentrations. Therefore, if the WENBIT study enrolled only patients with hyperhomocysteinemia, greater homocysteine reduction would have been expected, with possibly greater and significant reduction in primary or secondary clinical end points.

The WENBIT study was not . . . [Full Text of this Article]

George Ntaios, MD
ntaiosgeorge@yahoo.gr

Christos Savopoulos, MD; Apostolos Hatzitolios, MD
First Propedeutic Department of Internal Medicine
AHEPA Hospital
Thessaloniki, Greece

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