HOMOCYSTEINE AND CARDIOVASCULAR-DISEASE

An elevated level of total homocysteine (tHcy) in blood, denoted hyper homocysteinemia, is emerging as a prevalent and strong risk factor for atherosclerotic vascular disease in the coronary, cerebral, and perip heral vessels, and for arterial and venous thromboembolism. The basis for these conclusions is data from about 80 clinical and epidemiologic al studies including more than 10,000 patients. Elevated tHcy confers a graded risk with no threshold, is independent of but may enhance the effect of the conventional risk factors, and seems to be a particular ly strong predictor of cardiovascular mortality. Hyperhomocysteinemia is attributed to commonly occurring genetic and acquired factors inclu ding deficiencies of folate and vitamin B12. Supplementation with B-vi tamins, in particular with folic acid, is an efficient, safe, and inex pensive means to reduce an elevated tHcy level. Studies are now in pro gress to establish whether such therapy will reduce cardiovascular ris k.