Antioxidant Vitamins and Folic Acid: Recommendations Class III: No Benefit 1. Antioxidant vitamin supplements (eg, vitamins E, C, or beta carotene) should not be used for secondary prevention in patients with NSTE-ACS.474,475 (Level of Evidence: A) 2. Folic acid, with or without vitamins B6 and B12, should not be used for secondary prevention in pa- tients with NSTE-ACS.476,477 (Level of Evidence: A) Although there is an association of elevated homocysteine blood levels and CAD, a reduction in homocysteine levels with routine folate supplementation did not reduce the risk of CAD events in 2 trials (the NORVIT [Norwegian Vitamin Trial] and the HOPE [Heart Outcomes Prevention Evaluation] study) that included post MI or high-risk stable patients476 478 and produced poorer outcomes in another study.479 Additionally, in the NORVIT trial, there was a trend toward increased cardio- vascular events (95% CI: 1.00 to 1.50; P=0.05) in the cohort receiving the combination of folic acid, vitamin B6, and vita- min B12; the authors cautioned against using the treatment for Similarly, experience in large clinical trials with antioxidant vitamins has failed to demonstrate ben- efit for primary or secondary prevention.474,475,480 See Online Data Supplement 23 for additional information on antioxidant vitamins and folic acid. 6.4. Plan of Care for Patients With NSTE-ACS: Recommendations Class I 1. Posthospital systems of care designed to prevent hospital readmissions should be used to facilitate the transition to effective, coordinated outpatient care for all patients with NSTE-ACS.481 485 (Level of Evidence: B) 2. An evidence-based plan of care (eg, GDMT) that pro- motes medication adherence, timely follow-up with the healthcare team, appropriate dietary and physi- cal activities, and compliance with interventions for secondary prevention should be provided to patients with NSTE-ACS. (Level of Evidence: C) 3. 