Homocysteine, Cause or Consequence?

Although an association between hyperhomocysteinemia and cardiovascular risk has been described, to date, interventional trials about homocysteine-lowering therapy have shown no clinical benefit in patient with cardiovascular disease. Several explanations have been proposed for these unexpected results, but itʹs possible that homocysteine may represent an epiphenomenon in atherosclerosis. However, serum homocysteine levels are useful for risk stratification after an acute coronary event. The combination of the supposed most powerful biochemical markers (C-Reactive protein, troponin I, Nt-pro-BNP and homocysteine) with traditional clinical markers (age, heart failure, diabetes) would be the best strategy for risk stratification after an acute coronary event.