Homocysteine Is Not So Paradoxical

Abstract

To the Editor: Rodionov and Lentz1 summarized the homocysteine paradox. Hyperhomocysteinemia disrupts vascular structure and function in animals and predicts risk of “coronary events, stroke, venous thromboembolism, and death,” yet clinical benefit in intervention trials remains unproved. They offer several plausible explanations. Trials usually involve dietary supplementation with folate and vitamins B-6 and B-12. It also seems plausible that results would have been better if the intervention trials included copper. High homocysteine concentrations lead to increased homocysteine thiolactone,2 an …