Homocysteine and cardiovascular disease: time to routinely screen and treat?

Modest elevations in plasma homocysteine from either genetic or acquired causes appear to relate to cardiovascular disease on the basis of strong epidemiological evidence. We know that homocysteine can be lowered with varying doses of folic acid, with or without vitamins B6 and B12, although we do not yet know the potential cardiovascular benefit of vitamin supplementation in these subjects. Several multicentre interventional trials are underway to address this question and, until these are complete, we recommend a healthy diet high in folate replete foodstuffs. We also recommend oral folic acid supplements in some subjects with cardiovascular disease and high homocysteine, mindful that definitive evidence of benefit is lacking.