Homocysteine and vascular disease

• Published in: The Lancet (British edition) Vol. 354; no. 9176; pp. 407 - 413
• Main Authors: Hankey, Graeme J, Eikelboom, John W
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 31.07.1999; Lancet; Elsevier Limited
• Subjects: Amino acids; Arteriosclerosis - blood; Arteriosclerosis - etiology; Arteriosclerosis - prevention & control; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular Diseases - blood; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Coronary heart disease; Coronary vessels; Folic acid; Folic Acid - administration & dosage; Heart; Homocysteine - blood; Humans; Medical sciences; Public health; Randomized Controlled Trials as Topic; Risk Factors; Systematic review; Thrombosis - blood; Thrombosis - etiology; Thrombosis - prevention & control; Vascular diseases; Vitamins - administration & dosage; Vascular disease; Human; Cardiovascular disease; Thrombosis; Blood vessel; Risk factor
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(98)11058-9

For more than 20 years, moderately raised concentrations of total homocysteine (tHcy) have been associated with an increased risk of atherothrombotic vascular events but only recently has evidence mounted to suggest that the association may be causal. The association is independent of other factors, it is fairly consistent across many studies, it is strong and dose-related, and it is biologically plausible. However, the evidence needs to be strengthened by a systematic review of all comparable studies and the demonstration, in randomised trials, that lowering tHcy is followed by a significant reduction in atherothrombotic vascular disease. In addition, the measurement of tHcy needs to be standardised. If these can be achieved then tHcy measurement will become another useful marker of vascular risk, multivitamin therapy will be another therapeutic option for people at risk of atherothrombotic vascular disease, and fortification of food with folic acid will rise high on the political and public health agenda.