Association of vitamin B12 deficiency and hyperhomocystinemia with acute coronary syndromes - A case series.

Acute coronary syndromes (ACS) are the most common presentation of atherosclerotic cardiovascular diseases in the emergency department. Numerous risk factors such as smoking, low High Density Lipoprotein (HDL) levels, metabolic syndrome, high triglycerides, diabetes, etc. have been implicated in the development of coronary artery disease and ACS. The management tools instead of focusing on the reversal of the above risk factors relies on lipid lowering drugs. Our series of patients suffering from ACS shows a possible association with low serum vitamin B12, high homocysteine, high Triglyceride, low HDL, low cholesterol and low LDL levels. There needs to be a paradigm shift in managing patients of ACS and the advice prescribed to them at the time of discharge. It would be prudent for emergency physicians to test for vitamin B12 and homocysteine levels in ACS patients.