Is hyperhomocysteinemia an important risk factor of cardiovascular disease?

In the last couple of decades many studies have been carried out on the association of moderately high plasma levels of total homocysteine (tHcy) with coronary artery disease, cerebrovascular disease, peripheral artery disease and venous thromboembolism. Most studies showed a positive association between tHcy and thrombosis risk. However, despite this, many investigators are still skeptical about the importance of hyperhomocysteinemia as a thrombosis risk factor, because some important aspects of the association of hyperhomocysteinemia with cardiovascular diseases still need to be clarified. In the following few lines I will try to explain why I consider hyperhomocysteinemia a proven risk factor for cardiovascular diseases and then I'll address the question of whether or not it is an important risk factor. Is Hyperhomocysteinemia a Proven Cardiovascular Risk Factor?