TNF and metabolic syndrome: Homocysteine could produce complex changes within the blood vessel wall [30] and may cause CAD through the following 5 pathways [31–33]: (a) vascular endothelial cell damage and dysfunction; (b) dyslipidemia; (c) promotion of the expression of inflammatory factors (e.g., the expression of tumor necrosis factor-α and inducible nitric oxide (NO) synthase (iNOS)); (d) impaired endothelium-mediated platelet inhibition, which enhances coagulation function and induces thrombosis; and (e) stimulation of vascular smooth muscle cell proliferation.