In reply
We thank Mr Vos for his interest in our manuscript. In his comments, Mr Vos argues that "it is time to recommend an over-the-counter multivitamin to anyone at risk for cardiovascular conditions." We are unconvinced that existing data justify a general recommendation of this kind. Indeed, our own data suggest that in patients with unstable coronary syndromes, only a homocysteine level greater than the upper normal level is associated with increased risk of premature death.1