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doi: 10.1111/j.1365-2672.2006.02900.x 106

Elevated homocysteine level is associated with an increased risk for atherosclerotic and thrombotic events.45 Meta-analysis of 30 studies involving 5073 ischaemic heart disease (IHD) events suggested that elevated homocysteine level was at most a modest independent predictor of IHD and stroke risk in healthy populations, and a 25% reduction in homocysteine levels was associated with 11% and 19% reduction in IHD and stroke, respectively.46 Another meta-analysis also provided a strong evidence of the causal association between homocysteine and cardiovascular disease, and showed that lowering homocysteine level by 3 mol/L could reduce the risk of IHD by 16% and stroke by 24%.47 Vitamin B 12 , folic acid, and vitamin B 6 are required for homocysteine metabolism, and often nutritional deficiency of these vitamins can cause hyperhomocysteinaemia

Non-specific symptoms and signs are loss of appetite, diarrhoea, fatigue and weakness, shortness of breath, low blood pressure, confusion, and change in mental states.9 29 Classical manifestations include Hunters glossitis, megaloblastic anaemia, and subacute combined degeneration of spinal cord (Table 29)