Abstract: Many studies are related to high prevalence of hyperhomocysteinemia in Western Africa, suggesting the necessity to evaluate the consequence of this risk factor on diseases in this area. Some studies showed a strong association between hyperhomocysteinemia and stroke in these populations but studies on the relationship between hyperhomocysteinemia and coronary heart diseases are rare. The purpose of present study was to determine the correlation between hyperhomocysteinemia and coronary heart diseases in African patients. In this cross sectional study, we analyzed the relationship between hyperhomocysteinemia and coronary heart diseases just as other conventional risk factors in 207 admitted African patients divided into case and control groups based on the diagnosis of coronary heart disease, from January 2008 to June, 2011. There was no correlation between homocysteine level and conventional risk factors. The prevalence of hyperhomocysteinemia was 56.5% in patients with coronary heart diseases vs. 50% in patients without coronary heart disease, p = 0.37; OR = 1.30 (95% CI:0.72-2.33). However, 66.7% of patients with acute coronary syndrome vs., 48.4% of patients without acute coronary syndrome had hyperhomocysteinemia, p = 0.03; OR = 2.12 (1.04-4.32); in the same way, 75% of patients with myocardial infarction vs. 49.7% of patients without myocardial infarction had hyperhomocysteinemia, p = 0.03; OR = 3.03 (95% CI:1.06-8.7). The prevalence of hyperhomocysteinemia was 66.7% in patients with acute coronary syndrome vs. 40.7% in patients with stable angina pectoris, p = 0.03. These differences persisted after adjusting for age, gender and LDL cholesterol. There was a strong correlation between hyperhomocysteinemia and acute coronary syndromes in black African patients. Further prospective studies must be performed on this novel risk factor in this area.