Introduction. Abdominal obesity (AO) is one of the major risk factors of atherosclerosis and type 2 diabetes mellitus. Recently, the data on additional cardiovascular risk factors characterized by unclear interconnections with AO and other components of metabolic syndrome have become available. Hyperhomocysteinemia (HHcy) is considered one of those. Purpose. The study is aimed to evaluate the factors associated with hyperhomocysteinemia in patients with AO. Materials and methods. The study included 148 patients: 101 individuals with AO (main group) and 47 individuals without AO (control group). All patients underwent comprehensive check-up, including the following: history taking, physical examination, full blood count, biochemical tests (including evaluation of serum homocysteine level), estimation of GFR and SCORE index, and echocardiography. Student’s t-test, chi-squared test, and Pearson’s correlation coefficient were used for statistical analysis. Results and discussion. The average level of serum homocysteine was higher in patients with AO than in control group (p=0.023). The prevalence of HHcy was 26.7% in the main group and 14.9% in the control group. In both groups, HHcy was more prevalent in men than in women. Among patients with AO, the elevated level of HHcy was found in 37.5% of men and 13.3% of women (p=0.007). Patients from the main group with elevated and normal level of homocysteine had no significant differences in the presence of individual components of metabolic syndrome. In men with AO, the serum level of homocysteine correlated with the level of sex hormone-binding globulin (r=0.349, p=0.013) and E/A, the marker of left ventricular diastolic dysfunction (r=–0.313, p=0.032), in women – with body mass index (r=0.313, p=0.039), SCORE index (r=0.501, p=0.002), serum level of uric acid (r=0.299, p=0.048), and left ventricular mass index (r=0.426, p=0.017). Conclusion. The results of the study suggest that AO is associated with the increase of the serum level of homocysteine. Men are characterized by higher prevalence of HHcy than women. In addition, clinical and laboratory parameters associated with elevated level of homocysteine have significant gender differences. Further studies will promote differentiating of approaches to management of patients with AO and metabolic disorders.