With longer average life expectancy, the prevalence of cardiovascular disease in later life is rising. A growing body of epidemiological evidence has shown a strong association between elevated homocysteine plasma levels and cardiovascular disease in the general population. This review focuses on the role of homocysteine as an emerging risk factor for cardiovascular disease in the elderly. The possibility of a relatively easy correction of hyperhomocysteinemia by vitamin supplementation represents an important stimulus to reach a definitive conclusion regarding the pathophysiological role of homocysteine as risk factor for cardiovascular disease in the general population and, in particular, elderly subjects.