Elevated homocysteine associated with higher cardiovascular risk in young patients with myocardial infarction: the role of metabolic phenotypes

Background Premature myocardial infarction (PMI) is increasingly recognized as a metabolic disease, driven by a cluster of dysregulations including insulin resistance and central obesity. While homocysteine (Hcy)—an intermediate of one-carbon metabolism—is implicated in these atherothrombotic processes, its synergistic effect with coexisting cardiometabolic risk factors for the long-term prognosis of PMI patients remains unclear. Methods We conducted a prospective cohort study of 1,220 consecuti