Diagnosis and treatment of hyperhomocysteinemia.

Hyperhomocysteinemia has emerged as an important risk factor for cardiovascular disease. However, its place in clinical practice is somewhat unclear, due to the lack of clinical trials documenting the benefit of treatment on reducing cardiovascular events. Vitamin therapy, particularly with folic acid, reduces plasma homocysteine significantly and improves other surrogate markers of cardiovascular risk such as endothelial function. Although a consensus is lacking on the right approach to diagnosis and treatment of this risk factor, we have suggested an algorithm based on data from clinical studies. We are optimistic that such an approach will be helpful for the clinician until clinical trials, with cardiovascular events as endpoints, are completed.