Does the Available Literature about Hyperhomocysteinemia Cause Confusion to Clinicians?

Abstract

Background—Aim: Hyperhomocysteinemia (HHcy) (typically defined as serum total homocysteine/tHcy levels >15 μmol/L) has been associated with more than 100 diseases, syndromes, or outcomes. However, the current literature about the testing for or the treatment of HHcy causes confusion to clinicians. The aim of this study was to present and comment on the main causes of this confusion. Discussion: The main causes of the above confusion are the important limitations of clinical trials related to the management of HHcy, the false impression that measurement of serum tHcy levels is not useful generally in clinical practice, the inability of modern diet (poor in folate and rich in methionine) to reduce the serum tHcy levels, and, finally, the consequent exclusion of identifying individuals with genetic causes of HHcy, as MTHFR C677T gene mutation. Conclusion: The recommendations about the testing for or the treatment of HHcy must be clarified.