Vitamins B12 and B6 can also help. Much higher doses may be needed in people with end-stage kidney disease. In 1997, the FDA mandated a moderate level of folic acid fortification of grain products. Still, most people don't get enough folic acid. Because there's evidence that high folic acid can mask a deficiency of vitamin B12, the U-M group and others have recommended that B12 be taken along with any folic acid supplements.
Most multivitamins contain both nutrients, as do whole grains, oranges and green vegetables.
The U-M study was funded in part by the Agency for Healthcare Research and Quality. The study first looked at the effect on life expectancy and costs under the assumption that reducing homocysteine levels could reduce homocysteine-related heart disease risk 40 percent. Looking at the cost of the two approaches, however, the team found that despite the up-front blood test cost, the screening approach would cost up to 60 percent less in the long run, since vitamins would be targeted at those who could most benefit from reducing homocysteine levels.