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June 19, 1996


Author Affiliations

Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Mass

JAMA. 1996;275(23):1828-1829. doi:10.1001/jama.1996.03530470056033

Elevated blood homocysteine concentration is a newly recognized, independent risk factor for arteriosclerotic vascular disease. The underlying mechanisms for which some laboratory support exists are the roles of homocysteine as a vascular toxin, as a stimulator of the proliferation of smooth-muscle cells, and as a procoagulant, thrombogenic agent. In the Physicians' Health Study, blood homocysteine concentration correlated positively with the risk of myocardial infarction, even though many of the patients had levels in the "normal" range.1 Moreover, recent data from the Framingham Heart Study show that the degree of carotid artery stenosis is also positively related to the level of plasma homocysteine.2 In a meta-analysis of coronary artery disease and cerebral and peripheral vascular disease using case-control and cross-sectional studies, a consistent association was found between higher blood homocysteine levels and a higher relative risk for each of these diseases.3 For coronary artery disease, it was estimated