Abstract: Objective To investigate the predict value of homocysteine (HCY) for major adverse cardiovascular events risk among the community-dwelling female population. Methods This was a community-based prospective observational study.From September 2007 to January 2009,a total of 870 female subjects with average age of 58.81 years were recruited from a community-based population in Beijing.Participants were divided into group A (<12.3 μmol/L,n=212),group B (12.3-15.2μmol/L,n=221),group C (15.3-18.3μmol/L,n=218) and group D (≥18.4μmol/L,n=219) according to the baseline HCY level.Their baseline clinical data were recorded,indicators including major adverse cardiovascular events (MACE),HCY and cfPWV were detected.Patients were followed-up for average of 4.8 years,and MACE and all-cause mortality were also recorded,and the predictive role of HCY for major cardiovascular events was evaluated. Results Compared with group A,B and C,the age in group D was significantly higher,the levels of SBP,uric acid,cfPWV were higher,while levels of HDL-C and eGFR were significantly lower (all P<0.05).During a average 4.8-year follow-up period,23 participants (2.6%) died,42 participants (4.8%) suffered MACE.The incidences of MACE and all-cause mortality were significantly higher in group D compared to group A (7.3% vs 1.4%,5.5% vs 0.5%,P<0.01,respectively).Cox regression analysis showed that the risks of MACE and all-cause mortality were significantly higher in group D than that in group A after adjusting for traditional risk factors (P<0.05).The area under the ROC curve for HCY in predicting MACE and all-cause mortality were 0.615 (95% CI:0.533-0.698) and 0.695 (95% CI:0.583-0.806),respectively. Conclusion The plasma HCY level is a potential and independent predictive factor for major adverse cardiovascular events risk in female community population.