Homocysteinemia: role in vascular disease

Hereditary disease: Hereditary anomalies of homocysteine metabolism are qui te uncommon and manifest by very high homocysteine levels (> 100 mu mol/l) and associated homocysteinuria. The risk of premature cardiovascular diseas e is high. Clinical, biological and epidemiological data accumulated since the 70s have demonstrated that a moderately elevated serum homocysteine lev el favors the development of atherothrombosis. Proven risk: The risk of coronary or cerebral events is 1.5 to 3-fold highe r for fasting homocysteine levels above 15 mu mol/l. These data show that m oderately elevated homocysteine level is a powerful cardiovascular risk fac tor Further information is however needed to ascertain its frequency in the population and determine whether it is a truly independent risk factor. Therapeutic options: Most cases of moderately elevated homocysteine can pro bably be explained by gene-environment interactions. Homocysteine levels ca n be lowered by oral administration of vitamin cofactors implicated in homo cystein metabolims: folic acid, vitamin B6, vitamin B12.