To the Editor: Dr Albert and colleagues1 found that a combination of oral folic acid, vitamin B6, and vitamin B12 did not reduce total cardiovascular events among high-risk women after 7.3 years of treatment and follow-up despite significant homocysteine lowering. However, almost 70% of their cohort had folate concentrations greater than 7 ng/mL before supplementation (to convert folate to nmol/L, multiply by 2.266), suggesting that their prospective study was not performed in a folate-deficient population. In addition, the study population consisted of health professionals, a group at a relatively low risk of folate deficiency.
Akilzhanova A, Takamura N, Yamashita S. Effect of Folic Acid and B Vitamins on Cardiovascular Disease in Women. JAMA. 2008;300(12):1409-1410. doi:10.1001/jama.300.12.1409-b