Preventing adverse cardiovascular outcomes

Your recent helpful review of vitamins¹ might leave some readers with the impression that supplementing with vitamins in order to lower elevated plasma homocysteine levels will protect against heart disease. A well-done study showed that normalizing elevated plasma homocysteine does not prevent adverse cardiovascular outcomes.² It seems to me that a patient with high homocysteine levels would benefit from intensive cardiovascular risk factor lowering by lifestyle changes, statins, and whatever else is required to achieve the lipid targets for patients at high risk of cardiovascular illness.