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First, hyperhomocysteinemia detected only in the fasting state (approximately 23% of patients), which might mainly result from an inhibition of the homocysteine remethylation pathway (folate, cobalamin, or functional methionine synthase deficiencies or thermolabile MTHFR mutation), and which increases the cardiovascular risk 1.6-fold

Metformin action on AMP-activated protein kinase: a translational research approach to understanding a potential new target