Homocysteine: An Emerging Cardiovascular Risk Factor that Never Really Made it

Serum total homocysteine (tHcy) has been implicated in promoting venous thromboembolic events and atherosclerosis, manifested as coronary heart disease, stroke or peripheral arterial disease. Dietary supplementation with B vitamins that lower tHcy concentrations was expected to reduce cardiovascular disease (CVD) risk. However, recent metaanalyses of prospective observational studies and randomized controlled trials failed to show a role of tHcy in the pathogenesis of vascular disease or a benefit of B vitamins in CVD events. This review analyzes recent data on the potential of tHcy to cause health problems (if any) and the role of vitamin B supplementation in preventing them.