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July 14, 1993


Author Affiliations

Tufts University, Boston, Mass

JAMA. 1993;270(2):233-234. doi:10.1001/jama.1993.03510020101033

Micronutrients (vitamins and minerals) are the focal point of the most recent advances in nutrition, particularly as they relate to the prevention of chronic disease.

Coronary heart disease accounts for about 35% of deaths in the United States. Elevated levels of blood homocysteine have been shown to be associated with an increased risk of myocardial infarction, independent of other known risk factors.1 The mechanism whereby such damage occurs is uncertain, although homocysteine may act as a direct vascular toxin. Deficiencies of folic acid, vitamin B6, and vitamin B12 may all lead to moderate homocysteinemia by causing disturbances in homocysteine metabolism. Since folate and vitamin B6 deficiencies are particularly common among elderly Americans, the stage is now set for randomized controlled trials of vitamin supplementation to reduce the risk of coronary heart disease and other vascular diseases.2

In addition, preliminary evidence suggests that natural antioxidants (vitamin