Introduction

Homocysteine is a sulfur amino acid and an intermediate in the biochemical conversion of methionine to cysteine, a process called trans-sulfuration. Vincent Du Vigneaud and others elucidated the biochemistry of homocysteine over the period from the 1930s to the 1950s. In the early 1960s, the description and characterization of the inborn error of metabolism, homocystinuria, initiated a 40-year (and continuing) period of investigation that has revealed homocysteine as an independent risk factor for vascular disease. The association between elevated blood levels of homocysteine (hyperhomo-cysteinemia) and vascular disease may be similar in magnitude to the association between cholesterol and vascular disease, thus implicating hyperhomo-cysteinemia as a significant public health concern. Currently, large-scale intervention trials are being conducted to determine if supplements of the B vitamins folate, vitamin B12, and vitamin B6, each of which plays an integral role in homocysteine metabolism, reduce the incidence of vascular disease. If successful, B vitamin supplements may prove to be an inexpensive and safe prophylactic to reduce the risk of heart attacks and strokes.

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