Dysregulated homocysteine metabolism and cardiovascular disease and clinical treatments

Elevated homocysteine (Hcy) levels, known as hyperhomocysteinemia (HHcy), are recognized as a separate risk factor for cardiovascular disease. Mutations in methylenetetrahydrofolate reductase (MTHFR) and cystathionine beta synthase (CBS)-enzymes pivotal at the juncture of the trans-sulfuration and remethylation pathways-underlie the pathogenesis of HHcy. Although vitamin supplementation has been proven to effectively decrease Hcy levels, there is still uncertainty about whether this reduction translates to a decrease in the incidence rates from cardiovascular diseases (CVDs). This review seeks to explore the linking between Hcy and specific diseases, the role of Hcy in vascular homeostasis, and the research on the possible advantages of therapies designed to lower Hcy levels. Understanding the intricate mechanisms of their metabolism and interactions is essential for pharmacological treatments to mitigate the adverse effects associated with metabolic dysregulation of Hcy. Given the widespread availability and ease of use of Hcy test kits, we strongly advocate for the routine administration of rapid blood tests for individuals at high risk of CVDs, particularly among the elderly population.