The development of atherosclerotic changes and thromboembolism are common features in homocystinurics. Hence, we postulate a positive correlation between the level of homocyst(e)ine in the blood and the occurrence of coronary artery disease. Homocysteine is found either as free homocystine, cysteine-homocysteine mixed disulfide, or protein-bound homocyst(e)ine. In nonhomocystinuric subjects, most homocysteine molecules are detectable in the protein-bound form. Thus, protein-bound homocyst(e)ine in stored plasma which reflected total plasma homocyst(e)ine was determined in 241 patients with coronary artery disease (173 males and 68 females). The mean±SD total plasma homocyst(e)ine was 5.41±1.62 nmol/ml in male patients, 437±1.09 nmol/ml in male controls, 5.66±1.93 nmol/ml in female patients, and 4.16±1.62 nmol/ml in female controls. The differences between the patients with coronary artery disease and the controls were statistically significant (P < 0.0005).