There is a block in conversion of homocysteine to methionine resulting in hyperhomocysteinemia. Premature atherosclerosis and thromboembolism occurs - due to ↑ plasma homocysteine (increased plasma homocysteine found in 40% of all atherosclerosis patients). Hence, there is an increased risk of cardiovascular diseases in megaloblastic anemia.
The mechanism of atherosclerosis associated with homocystinuria is shown below:
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