Coronary heart disease (CHD) represents a significant global health concern, with a multifactorial pathogenesis involving various risk factors. Among these, hyperhomocysteinemia has emerged as a potentially modifiable risk factor requiring particular attention. This article examines the specific features of CHD in patients with hyperhomocysteinemia, addressing its epidemiological significance, pathophysiological mechanisms, and clinical implications. The review summarizes contemporary literature to elucidate how elevated homocysteine levels can lead to atherosclerosis, thrombosis, coronary heart disease, and myocardial infarction. Furthermore, it discusses diagnostic challenges and therapeutic strategies for managing CHD in individuals with hyperhomocysteinemia. Understanding these aspects is critical for optimizing preventive measures and treatment strategies aimed at reducing the global burden of CHD associated with elevated homocysteine levels.