Background: CAD is the major cause of death. Many factors are responsible for causing CAD, but in 5 to 10 percent of CAD patients have none of the known risk factors. Risk factor modification is an integral part of the management of patients who have or are at risk for cardiovascular disease. Clinicians who care for patients with cardiovascular disease should be aware of new risk factors. Significant associations exist between established and new risk factors, and better understanding of new risk factors may shed light on the pathogenetic mechanisms of established risk factors. Objectives: To study the association of homocysteine in patients with coronary heart disease. Methods: This study was conducted in 50 patients of CAD and 50 people as a control group. All patients underwent a standard clinical examination and a blood draw for a lipid profile and total fasting serum homocysteine assay. Pearson chi-square test was used to assess the statistical significance. P value of less than 0.01 indicates highly significant and value of less than 0.05 indicates significant. Results: The cutoff value of homocysteine used in this study was 17micro mol/L. In case group 43 patients (86%) were showed raised homocysteine, and in control group 12 patients (24%) were showed raised homocysteine. And here the p value is <0.001 with the relative risk of 19.45. It shows raised homocysteine is statistically highly significant. Conclusions: The association of hyperhomocysteinemia with CHD was significant. Homocysteine values were higher in smokers and hypertensives.