**Funding**

*Inflammatory Heart Diseases*

homocysteine level [98].

diseases [103].

risk of increased CIMT [100].

body mass index [108].

**Acknowledgements**

Rajaandra for their help.

supplementation.

plaque morphology and larger plaque area [101].

**9. Homocysteine and carotid intima-media thickness**

patients with raised serum homocysteine level [98, 99]. Furthermore, the presence of complicated atheromatous plaque was significantly associated with serum

The patients with serum homocysteine level > 15 μmol/L had increased risk of presence of carotid plaque and plaque in bilateral common carotid artery (CCA) [100]. An increase in serum homocysteine was independently associated with

The patients with serum homocysteine level of ≥8.6 μmol/L had higher risk of developing echolucent plaques [101]. In another study, the patients with raised serum homocysteine level had 1.28 times risk of developing advanced carotid plaques after adjustment for age and gender [102]. Advanced carotid plaques were defined as ulcerated plaque and plaques with incomplete fibrous cap [102]. These advanced carotid plaques resulted in a higher ischaemic stroke risk [102]. In the study by Zhang et al., raised serum homocysteine acted synergistically with hypertension; therefore there was a greater risk of having plaque in bilateral CCA [100]. Alvarez et al. reported that in the patients with carotid stenosis of more than 70% and were receiving surgical management, high homocysteine level was present in the patients with extracranial cerebrovascular

An increase in homocysteine level was significantly associated with an increase

According to Wu et al., there was correlation between serum homocysteine level

with carotid intima-media thickness and total number of plaques and unstable plaques [84]. He also reported that serum homocysteine level was correlated with stenosis of ICAs and external carotid arteries (ECA) [84]. In a study on middleaged asymptomatic women, serum homocysteine was significantly associated with atherosclerosis change after adjustment for age, LDL, diastolic blood pressure and

In conclusion, raised serum homocysteine should be diagnosed early as this can lead to increased CIMT, carotid plaque and extracranial carotid stenosis. Raised serum homocysteine level can be managed with folic acid and vitamin

We would like to thank Dr. Lattish Rao Threemurthy and Dr. Parathythasan a/l

in CIMT carotid intima-media thickness [104]. In a study on the patients with primary hypertension, serum homocysteine level was independently associated with CIMT [105]. A significant positive correlation between homocysteine and intima-media thickness was reported [106]. In another study conducted among the patients with Parkinson's disease receiving treatment, there was positive correlation with statistical significance between CIMT and serum homocysteine level [107]. The patients with raised serum homocysteine as well as hypertension had higher

**10. Association of serum homocysteine with atherosclerosis**

**144**

Supported by University of Malaya UMCares grant RU013-2017C.
