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Correspondence
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Volume 346:1093-1095 April 4, 2002 Number 14
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B Vitamins and Restenosis after Coronary Angioplasty

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To the Editor: Schnyder et al. (Nov. 29 issue)1 suggest that a combination of B vitamins lowers plasma homocysteine levels, which, in turn, reduces the rate of restenosis after coronary angioplasty. This effect is interpreted as evidence of a causal role of hyperhomocysteinemia in the progression of atherosclerotic disease. Observational studies and clinical trials have been unable to rule out the alternative hypothesis that serum folate, vitamin B12, or pyridoxine may have an independent inhibitory effect on atherosclerosis, with a secondary effect on the homocysteine level. Indeed, observational data from large, prospective studies, such as the Atherosclerosis Risk in . . . [Full Text of this Article]

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