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Breast Cancer in Older Women

hypercholesterolemia, and healthy siblings of patients with premature cardiovascular disease. 3–5 Our data show that F is safe and effective in a group representative of a larger population, namely high-risk subjects with a history of cardiovascular disease, thus broadening the spectrum of its potential applications. Interestingly, five patients had mild hyperhomocysteinemia, whereas the remaining five had values in the upper normal range. Although the definition and classification of hyperhomocysteinemia is still controversial, F supplementation appears to be beneficial not only in patients with severe hyperhomocysteinemia, but also in those with mild hyperhomocysteinemia or even in those with normal Hcy. This is confirmed by the observation that relatively low baseline Hcy:creatinine ratios still account for a significant proportion of the changes in Hcy, SBP, and PP. Interestingly, the effects of F on PWV and blood pressure are additive to those already achieved by conventional pharmacological treatment with cardioactive drugs. Second, PWV is a marker of cardiovascular risk as it relates to the presence and severity of atherosclerosis. 6 Therefore, its reduction following F supplementation indicates not only a modification of arterial function, but also probable cardiovascular disease risk reduction. Third, the Hcy lowering is associated with a parallel reduction of both SBP and PP, two established cardiovascular risk factors, thus providing substantial cardioprotection by reducing both arterial impedance and cardiac afterload. Moreover, the Hcy:creatinine ratio is a predictor of the BP changes, thus potentially allowing the identification of the “responders” versus “nonresponders” to F supplementation. The limitations of our study are related to its open design and the limited number of subjects. Therefore, largebased randomized controlled trials are needed to confirm that our findings would result in a reduction of cardiovascular endpoints.