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To the Editor: The WENBIT study by Dr Ebbing and colleagues¹ appears to refute the hypothesis of homocysteine as a cardiovascular risk factor. However, some important aspects were not considered in the article's discussion.

Homocysteine is a long-term risk factor. In the Gothenburg study,² women with a high homocysteine level showed a higher mortality only after a follow-up of more than 15 years. Thus, short-term follow-up after cardiovascular events will probably not be able to demonstrate a benefit of B vitamins.

Furthermore, there seems to be no continuous correlation between homocysteine and cardiovascular risk below a threshold of homocysteine level of 12 µmol/L.² In prospective studies, only participants in the highest quintile of baseline homocysteine had a significantly increased risk.³ In the WENBIT study, the mean homocysteine level at baseline was so low (approximately 11 µmol/L) that this would not be expected to act as a risk factor at all. . . . [Full Text of this Article]

Johannes Scholl, MD
scholl@preventionfirst.de
Prevention First–Private Practice for Preventive Medicine
Munich, Germany

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