
Cardiovascular disease (CVD) remains a significant global health challenge, with traditional risk factors explaining only about half of all cases. This study investigates the association between homocysteine (Hcy) levels and mortality risks in individuals with CVD using data from the NHANES 1999–2006 cohort. Among 1,739 participants aged 30 or older, 1,194 deaths were recorded over a median follow-up of 126 months, including 501 CVD-related deaths. Higher Hcy levels (T3 > 12.5 µmol/L) were associated with increased risks of both all-cause (HR 1.64, 95% CI 1.29–2.09, p < 0.0001) and CVD-specific mortality (HR 1.69, 95% CI 1.14–2.51, p = 0.0086). Subgroup analyses identified interactions with age, smoking, and serum vitamin B12 levels.
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