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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In response to the Editorial Comment &#8220;Homocysteinemia and vascular disease&#58; where we stand in 2022&#8221;&#44; recently published in the <span class="elsevierStyleItalic">Journal</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Laura Guerreiro&#44; Sofia Rosado Juli&#227;o and Mariana Alves present a Letter to the Editor entitled &#8220;Ischemic stroke and homocysteine&#58; to test or not to test&#63;&#8221;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In general&#44; this letter agrees with the main positions of the editorial&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> pointing out that&#44; according to the VITATOPS trial&#44; the impact of lowering homocysteine was very low in preventing cardiovascular events and that treatment with vitamin B supplements was of dubious benefit in preventing major vascular events&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Guerreiro et al&#46;&#8217;s letter also discusses the usefulness of testing homocysteinemia&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">According to the authors&#44; in their center assessment of homocysteine levels is limited to patients included in the &#8216;Stroke in young patients&#8217; protocol or for research purposes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This raises an important question that deserves consideration&#58; when to seek new&#44; less tested&#44; or minor risk factors&#63;</p><p id="par0030" class="elsevierStylePara elsevierViewall">It makes sense to look for rare causes or minor risk factors when there are no common causes or major risk factors that can explain the clinical situation&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the absence of very high previous cardiovascular risk&#44; young patients with stroke constitute a population that&#44; in my opinion&#44; justifies a wider assessment&#44; in particular looking for infrequent causes of the disease&#46; In these circumstances&#44; I agree with the idea of testing homocysteine levels in young patients with stroke&#46; These patients should probably also be tested for other rare conditions with a procoagulant effect&#44; such as protein S or protein C deficiency&#44; as well as excluding antiphospholipid syndrome&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">However&#44; in my view&#44; assessment of homocysteine and of other minor or dubious risk factors should not be limited to young patients&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the secondary prevention of atherosclerotic disease at whatever age&#44; I suggest homocysteine should be assessed shortly after diagnosis when conventional risk factors cannot explain the disease&#46; This logical opinion is supported by the data presented in Guerreiro et al&#46;&#8217;s letter&#44; in which the percentage of homocysteine levels above cutoff is greatest in the oldest group analyzed &#40;in the group aged 60 to 65 years&#44; two-thirds presented homocysteine above the cutoff&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In medium- and long-term follow-up&#44; I suggest looking for other causes if&#44; after appropriate medication and control of known factors&#44; the patient suffers repeated major atherosclerotic events&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Appropriately medicated patients who suffer repeated ischemic events after successful percutaneous coronary intervention are a good example of the need to go further in their assessment&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">To conclude&#44; I generally agree with Guerreiro et al&#46;&#8217;s letter that there is no indication for universal homocysteine testing and that this assessment should be limited to certain groups&#44; of which younger patients with stroke are one&#46; In my view&#44; testing homocysteine levels can also benefit patients with severe atherosclerotic disease not explained by conventional risk factors and&#44; in the follow-up&#44; homocysteine assessment can help patients with repeated atherosclerotic complications&#44; after following the best practice to control their known and proved prognostic factors&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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