[Hyperhomocysteinemia and B-vitamin deficiency. Current clinical aspects].

Mild to moderate hyperhomocysteinemia has been recognized as an independent risk factor for coronary heart diseases, neurodegenerative diseases, osteoporosis, and pregnancy complications. Low intakes and decreased absorption of the B-vitamins are the most common causes of hyperhomocysteinemia, which is very prevalent in elderly people. The current review summarizes results from epidemiological studies and presents possible pathological mechanisms of hyperhomocysteinemia. In addition, the current study is a critical evaluation of results from several intervention studies that have been initiated for primary or secondary prevention of coronary and degenerative diseases. Lowering the risk of stroke is currently the most impressive effect of homocysteine-lowering-treatment and underlines the causal relationship. Available data is not sufficient for a final conclusion about the effectiveness of homocysteine-lowering in patients with coronary vascular diseases. Current recommendations stress the importance of measurement of plasma concentrations of homocysteine in patients with multiple risk factors. This allow early intervention with B-vitamins.