One-carbon metabolism and cardiovascular disease: Molecular mechanisms, genetic influences, and epigenetic regulation

Hyperhomocysteinemia, characterized by elevated levels of circulating homocysteine, has emerged as a significant risk factor for cardiovascular disease (CVD). This literature review explores the multifactorial relationship between one-carbon metabolism (OCM) and cardiovascular health, focusing on the biological mechanisms that link OCM disruptions to vascular dysfunction and disease development. Emphasis is placed on the biochemical interplay between genetic polymorphisms, nutritional deficiencies (particularly B vitamins and folate), and epigenetic processes including DNA methylation, histone modifications, and non-coding RNAs. These alterations can affect gene expression, endothelial integrity, lipid metabolism, and inflammatory pathways, thereby increasing the risk of atherosclerosis, hypertension, and other CVDs. Promising therapeutic interventions-such as targeted supplementation and epigenetic-modulating strategies-are discussed as future tools for prevention and personalized treatment of cardiovascular disorders.