Background Cardiovascular disease (CVD) is a leading cause of death worldwide. Ischemic heart disease is a major cause of morbidity and mortality. Lack of blood supply to the brain can cause tissue death if any of the cerebral veins, carotid arteries, or vertebral arteries are blocked. An ischemic stroke describes this type of event. One of the byproducts of methionine metabolism, the demethylation of methionine, is homocysteine, an amino acid that contains sulfur. During myocardial ischemia, the plasma level of homocysteine (Hcy) increases and plays a role in many methylation processes. Hyperhomocysteinemia has only recently been recognized as a major contributor to the increased risk of cardiovascular disease (CVD) owing to its effects on atherothrombosis and improvement of oxidative stress-induced endothelial dysfunction, joining the ranks of other known risk factors such as hyperlipidemia, hypertension, diabetes, and advanced age. Objective The purpose of this study was to determine whether there is a relationship between elevated serum total homocysteine (tHcy) levels and an increased risk of coronary artery disease (CAD) in an Iraqi population of patients with ischemic heart disease. Methods This study was conducted at Madinat al-Imamain Al Kadhmain Hospital’s Cardiology Department in Baghdad, Iraq. The study lasted for six months and was designed as an observational case-control study from November 1, 2023, to April 1, 2024. Results Cases and controls had similar characteristics but differed significantly in serum homocysteine concentration. The mean homocysteine level in case group was 40.21±14.47 mmol/L and 9.23±2.41 mmol/L in control group with p value <0.001. Conclusion In young individuals, hyperhomocysteinemia is positively associated with coronary artery, even when other traditional risk factors are not present.