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
Omland T, Hartford M, Caidahl K. Multivitamin Supplements Are Effective and Inexpensive Agents to Lower Homocysteine Levels—Reply. Arch Intern Med. 2001;161(5):771–778. doi:
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