Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: In their randomized controlled
trial, Dr Toole and colleagues1 found that
a high-dose formulation of pyridoxine, cobalamin, and folic acid led to moderate
reduction of total homocysteine levels after nondisabling cerebral infarction,
but this did not translate into any benefit in terms of clinical end points.
Nonetheless, the authors also found that, across all patients, total homocysteine
levels were related to risk of clinical events, and thus they concluded that
serum homocysteine is a marker, rather than a cause of vascular disease.
Aguirre C, Ruiz-Irastorza G, Egurbide M, Martinez-Berriotxoa A. Vitamin Supplementation and Risk of Stroke. JAMA. 2004;291(18):2191-2192. doi:10.1001/jama.291.18.2191-a