Homocysteine and atherosclerosis

Elevated plasma total homocysteine is an independent risk factor for athero sclerotic vascular disease. Risk rises continuously across the spectrum of homocysteine concentrations and may become appreciable at levels greater th an 10 mu mol/l. A compelling case can be made for screening all individuals with atherosclerotic disease or at high risk. A reasonable, but unproven, goal for treatment is a plasma total homocysteine concentration less than 1 0 mu mol/l. Folic acid is the mainstay of treatment, but vitamins B-12 and B-6 may have added benefit in selected patients. The results of ongoing ran domized placebo-controlled trials will not be available for several years, but will help determine whether homocysteine lowering reduces the risk of c ardiovascular disease. Curr Opin Lipidol 10:417-428. (C) 1999 Lippincott Wi lliams & Wilkins.