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However, most of these studies lacked rigorous exclusion criteria in the selection of subjects to avoid the influence of confounders

In the same trend, Lee et al

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Homocysteine levels can be high for a number of reasons:[ref][ref] Insufficient folate and B12 (exacerbated by variants in MTHFR, MTR see genotype report below) Not enough B6 (CBS pathway, B6 see genotype report) More methionine than the body can handle Renal insufficiency (kidney disease) or alcoholism Genetic mutations in the CBS gene can cause rare cases of hyperhomocysteinemia