We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Relationship of Dietary Folate and Vitamin B6 With Coronary Heart Disease in Women—Reply

Kilmer S. McCully, MD
JAMA. 1998;280(5):417-419. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-5-jbk0805.
Text Size: A A A
Published online


In Reply.— Drs Cleophas and van der Meulen's recommendation for a prospective trial with homocysteine-lowering therapy echoes the first such recommendation published 26 years ago.1 A prospective controlled trial of homocysteine lowering by dietary improvement, vitamin therapy, smoking cessation, and other lifestyle improvements would add further evidence supporting the validity of the homocysteine theory of arteriosclerosis. That such a trial would meet with success is suggested by the Hordaland Homocysteine Study, which showed that plasma homocysteine levels reflect the known risk factors in the etiology of CHD.2 Patients with the homozygous form of cystathionine synthase deficiency and homocystinuria are more at risk for cerebrovascular, peripheral vascular, and thrombotic vascular disease than they are for CHD. This distribution of vascular disease may reflect the more generalized and accelerated nature of the arteriosclerotic process occurring in children compared with adults with CHD. Some patients with homocystinuria survive into adulthood despite prolonged exposure to elevated homocysteine levels, but many of them develop typical generalized arteriosclerosis. Sulfhydryl-bound homocysteine within plasma proteins may not accurately reflect the atherogenic process as closely as the homocysteine bound to small, dense low-density lipoprotein aggregates.3 Unfortunately, no assay has been developed for this potentially highly atherogenic form of homocysteine.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.