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Elevated homocysteine level is associated with an increased risk for atherosclerotic and thrombotic events.45 Meta-analysis of 30 studies involving 5073 ischaemic heart disease (IHD) events suggested that elevated homocysteine level was at most a modest independent predictor of IHD and stroke risk in healthy populations, and a 25% reduction in homocysteine levels was associated with 11% and 19% reduction in IHD and stroke, respectively.46 Another meta-analysis also provided a strong evidence of the causal association between homocysteine and cardiovascular disease, and showed that lowering homocysteine level by 3 mol/L could reduce the risk of IHD by 16% and stroke by 24%.47 Vitamin B 12 , folic acid, and vitamin B 6 are required for homocysteine metabolism, and often nutritional deficiency of these vitamins can cause hyperhomocysteinaemia