Screening recommendations for hyperhomocystinemia remain controversial and diverse. The lack of evidence substantiating clinical benefit of treatment of hyperhomo-cystinemia as well as unnecessary laboratory costs are potent arguments against recommending widespread screening. A. American Heart Association Recommendation
The American Heart Association does not recommend population screening. Theydosuggest, however, that screen¬ing may be useful in certain high-risk patients with con¬ditions known to be associated with hyperhomocystinemia.
B. European International Task Force Recommendation
The European International Task Force for the Prevention of Coronary Heart Disease recommends the measurement of homocysteine in patients with premature coronary artery disease or stroke in the absence of the well-established vascular risk factors. This appears to be a reasonable approach in young individuals with stroke prior to age 45 caused by cerebral thrombosis (intracerebral hemorrhage and subarachnoid hemorrhage should be excluded) and in patients with acute myocardial infarction prior to age 35. These ages are selected by the author to clarify the above recommendations, because at this age these conditions are rare as strokes usually occur after age 55 in men and women and heart attacks commonly occur in men after age 40 and women after age 60.

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