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is available, selenium sup- plementation is not advised for CHD.  Keep in mind that selenium may still play a role in other cardiovascu- lar conditions involving heart muscle disorders not involving coronary heart disease. Folic Acid, vitamin B6 and B12 may be the appropriate choice. Homocysteine is an amino acid which is abnormally elevated in 30% of people. Its elevation in the blood stream has been clearly linked to the formation of plaque within the heart arteries (50). Low folic acid levels have been linked to elevated homocysteine lev- els and an increased risk of myocardial infarction, com- monly known as a heart attack (51). In affected indi- viduals, folic acid taken along with vitamins B6 and B12 can reduce these lev- els (50,52-54).  While this combination of supple- ments has been shown to improve blood flow through the heart arteries in healthy volunteers, limited research has been done demonstrat- ing a reduction in either plaques within the heart arteries or the associated heart attacks, death, etc. which result from plaque formation (55). While it is a logical extension to think or diabetes mellitus. Participants who took 100 IU (International Unit) of vitamin E daily for at least two years had a 39% reduction in heart disease or cardiovascular surgery (56).  The US Nurses' Health Study included 121,000 female nurses between 30 and 44 years old (57).  Participants tak- ing 100 IU of vitamin E daily had a 34% lower incidence of coronary heart disease after just two years compared to those participants not tak- ing vitamin E. The above positive results also prompted large-scale randomized trials to further examine the benefits of vitamin E in patients with known heart disease or at very high risk.  Initial stud- ies where very encourag- ing. The Cambridge Heart Antioxidant Study (CHAOS) focused on whether supplements - either 400 or 800 IU of vitamin E daily - would prevent future cardiovas- cular events in patients with known coronary artery disease (58).  Of 2,002 patients with docu- mented coronary artery disease, treatment with vitamin E instead of place- bo significantly reduced the incidence of non-fatal folic acid, vitamin B6 and B12 treatment for people with ele- vated homocysteine levels may reduce heart attacks and other cardiovascular events, it has yet to be demonstrated in any clinical trials.  Based upon what is currently known, supplementation is felt to have a postive effect, particu- larly in those individuals iden- tified as having an elevated homocysteine level.  Prior to supplementation with folic acid, and vitamins B6 and B12, consider the appropriate medical testing. The supple- mentation level of folic acid is 800 mcg taken along with a multivitamin, which commonly supplies an additional 400 mcg, for a total daily dosage of 1200 mcg. The supplemen- tation level of vitamin B12 is 1000 mcg, or 1 mg daily, and for vitamin B6, 100 mg.  For effective treatment of elevated homocysteine, all three sup- plements are required. Vitamin E is a good antioxi- dant to remember. The bio- logic activity of vitamin E appears to prevent damage to cell walls through a variety of mechanisms in part due to its antioxidant effects.  Its role in preventing heart disease in patients without known heart disease has been encourag- ing.  The Health Professionals' Follow-up Study examined 39,910 males without known disease

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