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Xu Y, Feng H, Zhang L, Li Y, Chi F, Ren L. Prevalence and clinical correlates of hyperhomocysteinemia in Chinese urban population with hypertension. Front Endocrinol (Lausanne) 2024; 15:1369997. [PMID: 38444590 PMCID: PMC10912325 DOI: 10.3389/fendo.2024.1369997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
Context The coexistence of hypertension and elevated homocysteine (Hcy) levels has a mutually reinforcing impact on the susceptibility to cardio-cerebrovascular disease. Objective The aim was to assess the prevalence, clinical correlation, and demographic characteristics of hyperhomocysteinemia (HHcy) within the Chinese urban population with hypertension. Methods A cohort of 473 individuals with hypertension were selected from four communities in Shenzhen, China. Demographic attributes, clinical profiles, and lifestyle behaviors were gathered and compared between individuals with and without HHcy. A logistic regression model was employed to examine potential factors associated with the prevalence of HHcy. Correlation between Hcy levels and clinical characteristics was assessed through multiple linear regression analysis. Results The prevalence of HHcy in the population with hypertension was 31.3%. In comparison to individuals without HHcy, those with HHcy exhibited a higher proportion of males, a higher prevalence of smoking and alcohol consumption, and a higher proportion of cases with the homozygous (TT) genotype at the MTHFR C677T polymorphism. Moreover, individuals with HHcy had lower levels of folic acid (FA), and lower fruit and vitamin B12 intake. Furthermore, the risk factors for HHcy were male (B = 1.430, OR = 4.179) and MTHFR (TT) (B = 1.086, OR = 2.961). In addition, the multiple linear regression analysis revealed a significant association between Hcy levels and gender (B = -2.784, P = 0.004), MTHFR genotypes (B = 1.410, P = 0.005), and FA levels (B = -0.136, P = 0.030). Conclusion The high prevalence of HHcy among hypertensive patients in this Chinese urban population underscores the necessity for interventions targeting modifiable risk factors such as dietary choices and lifestyle practices.
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Affiliation(s)
| | | | | | | | | | - Lijie Ren
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
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Zeng J, Zhang R, Zhao T, Wang H, Han L, Pu L, Jiang Y, Xu S, Ren H, Wang C. Plasma lipidomic profiling reveals six candidate biomarkers for the prediction of incident stroke in patients with hypertension. Metabolomics 2024; 20:13. [PMID: 38180633 DOI: 10.1007/s11306-023-02081-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION The burden of stroke in patients with hypertension is very high, and its prediction is critical. OBJECTIVES We aimed to use plasma lipidomics profiling to identify lipid biomarkers for predicting incident stroke in patients with hypertension. METHODS This was a nested case-control study. Baseline plasma samples were collected from 30 hypertensive patients with newly developed stroke, 30 matched patients with hypertension, 30 matched patients at high risk of stroke, and 30 matched healthy controls. Lipidomics analysis was performed by ultrahigh-performance liquid chromatography-tandem mass spectrometry, and differential lipid metabolites were screened using multivariate and univariate statistical methods. Machine learning methods (least absolute shrinkage and selection operator, random forest) were used to identify candidate biomarkers for predicting stroke in patients with hypertension. RESULTS Co-expression network analysis revealed that the key molecular alterations of the lipid network in stroke implicate glycerophospholipid metabolism and choline metabolism. Six lipid metabolites were identified as candidate biomarkers by multivariate statistical and machine learning methods, namely phosphatidyl choline(40:3p)(rep), cholesteryl ester(20:5), monoglyceride(29:5), triglyceride(18:0p/18:1/18:1), triglyceride(18:1/18:2/21:0) and coenzyme(q9). The combination of these six lipid biomarkers exhibited good diagnostic and predictive ability, as it could indicate a risk of stroke at an early stage in patients with hypertension (area under the curve = 0.870; 95% confidence interval: 0.783-0.957). CONCLUSIONS We determined lipidomic signatures associated with future stroke development and identified new lipid biomarkers for predicting stroke in patients with hypertension. The biomarkers have translational potential and thus may serve as blood-based biomarkers for predicting hypertensive stroke.
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Affiliation(s)
- Jingjing Zeng
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo No.2 Hospital, Ningbo, 315000, China
- Center for Cardiovascular and Cerebrovascular Epidemiology and Translational Medicine, Ningbo Institute of Life and Health Industry, Guoke Ningbo Life Science and Health Industry Research Institute, Ningbo, 315000, China
- Department of Cardiology, Ningbo No.2 Hospital, Ningbo, 315000, China
| | - Ruijie Zhang
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo No.2 Hospital, Ningbo, 315000, China
- Center for Cardiovascular and Cerebrovascular Epidemiology and Translational Medicine, Ningbo Institute of Life and Health Industry, Guoke Ningbo Life Science and Health Industry Research Institute, Ningbo, 315000, China
| | - Tian Zhao
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo No.2 Hospital, Ningbo, 315000, China
- Center for Cardiovascular and Cerebrovascular Epidemiology and Translational Medicine, Ningbo Institute of Life and Health Industry, Guoke Ningbo Life Science and Health Industry Research Institute, Ningbo, 315000, China
| | - Han Wang
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo No.2 Hospital, Ningbo, 315000, China
- Center for Cardiovascular and Cerebrovascular Epidemiology and Translational Medicine, Ningbo Institute of Life and Health Industry, Guoke Ningbo Life Science and Health Industry Research Institute, Ningbo, 315000, China
| | - Liyuan Han
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo No.2 Hospital, Ningbo, 315000, China
- Center for Cardiovascular and Cerebrovascular Epidemiology and Translational Medicine, Ningbo Institute of Life and Health Industry, Guoke Ningbo Life Science and Health Industry Research Institute, Ningbo, 315000, China
| | - Liyuan Pu
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo No.2 Hospital, Ningbo, 315000, China
- Center for Cardiovascular and Cerebrovascular Epidemiology and Translational Medicine, Ningbo Institute of Life and Health Industry, Guoke Ningbo Life Science and Health Industry Research Institute, Ningbo, 315000, China
| | - Yannan Jiang
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo No.2 Hospital, Ningbo, 315000, China
- Center for Cardiovascular and Cerebrovascular Epidemiology and Translational Medicine, Ningbo Institute of Life and Health Industry, Guoke Ningbo Life Science and Health Industry Research Institute, Ningbo, 315000, China
| | - Shan Xu
- Department of Non-Communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518000, China
| | - Huiming Ren
- Department of Rehabilitation Medicine, Ningbo No.2 Hospital, Ningbo, 315000, China.
| | - Changyi Wang
- Department of Non-Communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518000, China.
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Fan F, David Spence J, Huo Y. Beyond hypertension: hypertension with hyperhomocysteinemia. Sci Bull (Beijing) 2023; 68:1975-1977. [PMID: 37612221 DOI: 10.1016/j.scib.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing 100034, China; Institute of Cardiovascular Disease, Peking University First Hospital, Beijing 100034, China; Hypertension Precision Diagnosis and Treatment Research Center, Peking University First Hospital, Beijing 100034, China
| | - J David Spence
- Divisions of Neurology and Clinical Pharmacology, Western University, London ON N6G 2V4, Canada
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing 100034, China; Institute of Cardiovascular Disease, Peking University First Hospital, Beijing 100034, China; Hypertension Precision Diagnosis and Treatment Research Center, Peking University First Hospital, Beijing 100034, China.
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Bao H, Huang X, Li P, Sheng C, Zhang J, Wang Z, Song D, Hu L, Ding C, Cheng Z, Yao C, Chen G, Cui Y, Qin X, Tang G, Wang X, Huo Y, Cheng X, Wang J. Combined use of amlodipine and folic acid are significantly more efficacious than amlodipine alone in lowering plasma homocysteine and blood pressure among hypertensive patients with hyperhomocysteinemia and intolerance to ACEI: A multicenter, randomized, double-blind, parallel-controlled clinical trial. J Clin Hypertens (Greenwich) 2023; 25:689-699. [PMID: 37433173 PMCID: PMC10423753 DOI: 10.1111/jch.14697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/12/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
Hyperhomocysteinemia with hypertension can synergistically increase the risk of stroke. The China stroke primary prevention trial showed that combining 0.8 mg folic acid (FA) with angiotensin-converting enzyme inhibitor (ACEI) can effectively lower plasma total homocysteine (tHcy) and blood pressure (BP); and reduce first stroke risk by additional 21% compared to ACEI alone. However, intolerance to ACEI is common in Asians and amlodipine can be alternative. This is a multicenter, randomized, double-blind, parallel-controlled clinical trial (RCT) which evaluated whether amlodipine combined with FA is more efficacious than amlodipine alone in lowering tHcy and BP among Chinese hypertensive with hyperhomocysteinemia and intolerance to ACEI. 351 Eligible patients were randomly assigned by 1:1:1 ratio to receive amlodipine-FA tablet daily (amlodipine 5 mg/FA 0.4 mg, A group); amlodipine 5 mg/FA 0.8 mg tablet daily (B group); amlodipine 5 mg daily (C group, control group). Follow-up was conducted at 2, 4, 6, and 8 weeks. The primary outcome was efficacy of lowering both tHcy and BP at the end of 8-week treatment. Compared with C group, A group had a significantly higher rate of lowering both tHcy and BP (23.3% vs. 6.0%; Odds Ratio [OR], 8.68; 95% CI, 3.04-24.78, P < .001); B group also had a higher rate of lowering both tHcy and BP (20.3% vs. 6.0%; OR: 5.90; 95% CI, 2.11-16.47, P < .001). This RCT showed amlodipine combined with FA compared with amlodipine alone, each had significantly higher efficacy of lowering both tHcy and BP. No difference was found in BP-lowering and occurrence of adverse events between the three groups.
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Affiliation(s)
- Huihui Bao
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Xiao Huang
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Ping Li
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Changsheng Sheng
- The Shanghai Institute of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Jin Zhang
- The Shanghai Institute of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Zhirong Wang
- Affiliated Hospital of Xuzhou Medical CollegeXuzhouChina
| | | | - Lihua Hu
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Congcong Ding
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Zaihua Cheng
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Chen Yao
- Peking University Clinical Research InstitutePeking University Health Science CenterBeijingChina
| | - Guangliang Chen
- College of Integrated Chinese and Western MedicineAnhui University of Chinese MedicineHefeiChina
| | - Yimin Cui
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Xianhui Qin
- National Clinical Research Study Center for Kidney Diseasethe State Key Laboratory for Organ Failure ResearchRenal DivisionNanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Genfu Tang
- School of Health AdministrationAnhui Medical UniversityHefeiChina
| | - Xiaobin Wang
- Department of PopulationFamily and Reproductive HealthJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Yong Huo
- Department of CardiologyPeking University First HospitalBeijingChina
| | - Xiaoshu Cheng
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Jiguang Wang
- The Shanghai Institute of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
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Futschek IE, Schernhammer E, Haslacher H, Stögmann E, Lehrner J. Homocysteine - A predictor for five year-mortality in patients with subjective cognitive decline, mild cognitive impairment and Alzheimer's dementia. Exp Gerontol 2023; 172:112045. [PMID: 36509298 DOI: 10.1016/j.exger.2022.112045] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/16/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Subjective Cognitive Decline (SCD) and Mild Cognitive Impairment (MCI) are preclinical stages of Alzheimer's Disease (AD), which is the most common entity of dementia. Homocysteine is an amino acid in the methionine cycle, and many studies revealed a significant association between elevated homocysteine serum levels and the progression of dementia. The primary objective of this retrospective study was to investigate whether elevated homocysteine serum levels could be associated with mortality and neuropsychological test results in individuals suffering from SCD, MCI or AD. METHODS This study is a single-center explorative retrospective data analysis with 976 data protocols from the Memory Outpatient's Clinic of the Medical University of Vienna included. All patients underwent a neurological examination, a laboratory blood test, and neuropsychological testing to establish a diagnosis of either SCD, MCI, or AD. Data was evaluated by Kaplan-Meier functions, factor analysis, and binary logistic regression models. RESULTS Patients with AD showed significantly higher mean homocysteine levels (SCD 12.15 ± 4.71, MCI 12.80 ± 4.81, AD 15.0 ± 6.44 μmol/L) compared to those with SCD and MCI (p ≤ .001). The mean age of patients with AD (75.2 ± 7.8) was significantly older at the time of testing than of patients with MCI (69.1 ± 9.6) or SCD (66.8 ± 9.3). Since homocysteine levels increase with age, this could be a possible explanation for the higher levels of AD patients. The age at death did not differ significantly between all diagnostic subgroups, resulting in the shortest survival times for AD patients. Homocysteine levels were negatively associated with in Mini-Mental State Examination (MMSE) and Neuropsyhcological Test Battery Vienna (NTBV) factors F1-F4 (F1 = attention, F2 = memory, F3 = executive functions, F4 = naming/verbal comprehension). Moreover, higher homocysteine levels significantly predicted shorter five-year survival in the logistic regression models, even after adjusting for age, diagnostic subgroups, sex, years of education and results of neuropsychological testing. CONCLUSION The results of this study suggest that homocysteine levels are independently associated with impaired cognitive function and increased five-year mortality.
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Affiliation(s)
| | - E Schernhammer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - H Haslacher
- Department of Laboratory Medicine, Medical University of Vienna
| | - E Stögmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - J Lehrner
- Department of Neurology, Medical University of Vienna, Vienna, Austria.
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Li Y, Chen X, Zhou R, Xu W, Wang X, Chao W, Xue S. Correlation Between Cognitive Impairment and Homocysteine and S100B Protein in Patients with Progressive Ischemic Stroke. Neuropsychiatr Dis Treat 2023; 19:209-217. [PMID: 36714163 PMCID: PMC9875579 DOI: 10.2147/ndt.s393624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/13/2023] [Indexed: 01/21/2023] Open
Abstract
PURPOSE This study aimed to investigate the relationship between cognitive impairment and homocysteine (Hcy) and S100B protein in patients with progressive ischemic stroke (PIS). PATIENTS AND METHODS A total of 158 patients with PIS hospitalized in the Department of Neurology in Taixing People's Hospital from January 2020 to March 2022 were enrolled in the study. After 90 days of follow-up, the patients were divided into two groups according to the MoCA score-99 cases with cognitive impairment group (observation group) and 59 cases with cognitive normal group (control group). Causal diagram was drawn to assess the association between risk factors and PIS with observation group. The risk factors indicators of cognitive impairment in patients with PIS were screened. The related predictive indicators were screened by multivariate logistic regression analysis, and Pearson correlation analysis. The predictive value was analyzed by Receiver Operating Characteristic (ROC) curve. RESULTS Multivariate logistic regression analysis showed that age, hypertension, lesion position, Hcy and S100B protein were related risk factors for cognitive impairment in patients with PIS. Pearson correlation analysis was conducted between Hcy and S100 B protein and MoCA score, and revealed that Hcy and S100 B protein were negatively correlated with MoCA score. ROC curve analysis showed that the Area Under the Curve (AUC) of S100 B protein and Hcy in identifying cognitive impairment after PIS was 0.709 and 0.673, respectively, and the combined AUC of Hcy and S100B protein in predicting cognitive impairment after PIS was 0.739. CONCLUSION Hcy and S100B protein are related risk factors for cognitive impairment in patients with PIS, and may be used as in a prediction model to predict cognitive impairment after PIS in the future.
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Affiliation(s)
- Yan Li
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Department of Neurology, The Taixing People's Hospital, Taixing, People's Republic of China
| | - Xiaopeng Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Department of Neurology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, People's Republic of China
| | - Rujuan Zhou
- Department of Neurology, The Taixing People's Hospital, Taixing, People's Republic of China
| | - Wu Xu
- Department of Neurology, The Taixing People's Hospital, Taixing, People's Republic of China
| | - Xiaorong Wang
- Department of Neurology, The Taixing People's Hospital, Taixing, People's Republic of China
| | - Wa Chao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Shouru Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
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Homocysteine is associated with higher risks of ischemic stroke: A systematic review and meta-analysis. PLoS One 2022; 17:e0276087. [PMID: 36227950 PMCID: PMC9560514 DOI: 10.1371/journal.pone.0276087] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/28/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High levels of homocysteine (Hct) have been associated with great risks of ischemic stroke. However, some controversy still exists. We performed a systematic review and meta-analysis to compare the levels of Hct between patients with ischemic stroke and controls. METHODS We performed a systematic literature search for articles reporting Hct levels of patients with occurrence of ischemic stroke. We employed a random-effects inverse-variance weighted meta-analytical approach in order to pool standardized mean differences, with estimation of τ2 through the DerSimonian-Laird method. RESULTS The initial search yielded 1361 studies. After careful analysis of abstracts and full texts, the meta-analysis included data from 38 studies, which involved almost 16 000 stroke events. However, only 13 studies reported means and standard deviations for cases and controls, and therefore were used in the meta-analysis. Those studies presented data from 5002 patients with stroke and 4945 controls. Standardized mean difference was 1.67 (95% CI 1.00-2.25, P < 0.01), indicating that Hct levels were significantly larger in patients with ischemic stroke compared to controls. Between-study heterogeneity was very large (I2 = 99%), particularly because three studies showed significantly large mean differences. CONCLUSION This meta-analysis shows that patients with ischemic stroke have higher levels of Hct compared to controls. Whether this is a modifiable risk factor remains to be assessed through larger prospective cohorts.
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Dose-response association between plasma homocysteine and white matter lesions in patients with hypertension: a case-control study. Hypertens Res 2022; 45:1794-1801. [PMID: 35999281 DOI: 10.1038/s41440-022-00999-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/05/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022]
Abstract
White matter lesions (WMLs) are common MRI changes that are indicative of cerebral small vessel disease (CSVD). Elevated plasma homocysteine (Hcy) levels are related to an increased risk of vascular disease. We aimed to analyze the relationship between Hcy levels and WMLs in patients with hypertension. A total of 1961 patients with WMLs and 15,463 patients without WMLs were matched at a 1:1 ratio by age and sex. Hyperhomocysteinemia (HHcy) was defined as an abnormally high level (>15 µmol/l) of Hcy in a plasma sample. In total, 1888 (WML group) and 1888 (No-WMLs group) patients were enrolled, with 51.6% of the sample being male and a mean age of 63 years. Multivariate logistic regression analysis showed a significant association between a higher level of plasma Hcy and a higher prevalence of WMLs (OR 1.03 95% CI, 1.02-1.04) when the Hcy level was used as a continuous variable. Patients with Hcy levels of 15-20 µmol/l (OR 1.54, 95% CI 1.31-1.81) and >20 µmol/l (OR 1.51, 95% CI 1.26-1.82) also had a significantly higher risk of WMLs than patients with Hcy levels <15 µmol/l. Multivariable-adjusted spline regression models showed that the risk of WMLs started to increase only in patients with Hcy levels above 13.85 µmol/l (P < 0.001). In subgroup analyses of WMLs, there was no significant interaction between the Hcy group and subgroup heterogeneity for the prevalence of WMLs (P > 0.05). Our study found a dose-response association between plasma homocysteine levels, especially a Hcy level >13.85 µmol/l, and the prevalence of WMLs, implying that lowering Hcy levels might be a target for prevention.
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Choi JH, Seo JW, Lee MY, Lee YT, Yoon KJ, Park CH. Association between Elevated Plasma Homocysteine and Low Skeletal Muscle Mass in Asymptomatic Adults. Endocrinol Metab (Seoul) 2022; 37:333-343. [PMID: 35144330 PMCID: PMC9081311 DOI: 10.3803/enm.2021.1202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/02/2021] [Accepted: 11/29/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Homocysteine has been drawing attention with a closed linkage with skeletal muscle. However, the association of hyperhomocysteinemia with decreased skeletal muscle mass remains unclear. We aimed to investigate the association of hyperhomocysteinemia with low skeletal muscle mass (LMM) in asymptomatic adults. METHODS This was a cross-sectional study of 114,583 community-dwelling adults without cancer, stroke, or cardiovascular diseases who underwent measurements of plasma homocysteine and body composition analysis from 2012 to 2018. Hyperhomocysteinemia was defined as >15 μmol/L. Skeletal muscle mass index (SMI) was calculated based on appendicular muscle mass (kg)/height (m)2. Participants were classified into three groups based on SMI: "normal," "mildly low," and "severely low." RESULTS The prevalence of hyperhomocysteinemia was the highest in subjects with severely LMM (12.9%), followed by those with mildly LMM (9.8%), and those with normal muscle mass (8.5%) (P for trend <0.001). In a multivariable logistic regression model, hyperhomocysteinemia was significantly associated with having a mildly LMM (odds ratio [OR], 1.305; 95% confidence interval [CI], 1.224 to 1.392) and severely LMM (OR, 1.958; 95% CI, 1.667 to 2.286), respectively. One unit increment of log-transformed homocysteine was associated with 1.360 and 2.169 times higher risk of having mildly LMM and severely LMM, respectively. CONCLUSION We demonstrated that elevated homocysteine has an independent association with LMM in asymptomatic adults, supporting that hyperhomocysteinemia itself can be a risk for decline in skeletal musculature.
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Affiliation(s)
- Jae-Hyeong Choi
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Woo Seo
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Taek Lee
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Jae Yoon
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Medical Research Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chul-Hyun Park
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Medical Research Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Zhou F, Liu C, Ye L, Wang Y, Shao Y, Zhang G, Duan Z, Chen J, Kuang J, Li J, Song Y, Liu L, Zalloua P, Wang X, Xu X, Zhang C. The Relative Contribution of Plasma Homocysteine Levels vs. Traditional Risk Factors to the First Stroke: A Nested Case-Control Study in Rural China. Front Med (Lausanne) 2022; 8:727418. [PMID: 35127734 PMCID: PMC8811122 DOI: 10.3389/fmed.2021.727418] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundApproximately 75% of Chinese hypertensive patients have elevated homocysteine (Hcy). Its implication in risk assessment and prevention of the first stroke remains an important clinical and public health question.MethodsThis study was based on a community cohort recruited from 2016 to 2018 in the rural China. To maximize cost efficiency, we used a nested case-control design, including 3,533 first stroke cases and 3,533 controls matched for age ±1 years, sex, and village. Individual associations of tHcy and traditional risk factors with the first stroke were examined, and their population-attributable risks (PARs) were estimated.ResultsThere was a significant dose-response association between first stroke and total Hcy (tHcy) levels, with adjusted odds ratios of 1.11 (95% CI: 0.97, 1.26) for tHcy 10–15 μmol/L and 1.44 (1.22, 1.69) for tHcy ≥ 15 μmol/L, all compared to tHcy < 10 μmol/L. A similar trend was found for ischemic and hemorrhagic stroke. tHcy and systolic blood pressure (SBP) were independently and additively associated with the risk of first stroke (tHcy: 1.06 [1.02, 1.1]; SBP: 1.13 [1.1, 1.16]; P-interaction, 0.889). Among the ten main risk factors examined, the top two contributors to the first stroke were SBP and tHcy, with PARs of 25.73 and 11.24%, respectively.ConclusionsElevated tHcy is the second most important contributor and acts additively with SBP to increase the risk of the first stroke. This finding underscores the importance of screening and treating elevated tHcy along with traditional risk factors to further reduce the burden of the first stroke in the high-risk populations.
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Affiliation(s)
- Feng Zhou
- Department of Neurology, First People's Hospital of Foshan, Foshan, China
- Research Center of Clinical Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chengzhang Liu
- Shenzhen Evergreen Medical Institute, Shenzhen, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Lijing Ye
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yukai Wang
- Department of Neurology, First People's Hospital of Foshan, Foshan, China
| | - Yan Shao
- Department of Neurology, First People's Hospital of Foshan, Foshan, China
| | - Guohua Zhang
- Department of Neurology, First People's Hospital of Foshan, Foshan, China
| | - Zhenpeng Duan
- Department of Neurology, First People's Hospital of Foshan, Foshan, China
| | - Jingjuan Chen
- Department of Neurology, First People's Hospital of Foshan, Foshan, China
| | - Jingyun Kuang
- Department of Neurology, First People's Hospital of Foshan, Foshan, China
| | - Jingyi Li
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yun Song
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Lishun Liu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Pierre Zalloua
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Xiping Xu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
- The State Key Laboratory for Organ Failure Research, National Clinical Research Study Center for Kidney Disease, Guangzhou, China
- Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Xiping Xu
| | - Chengguo Zhang
- Department of Neurology, First People's Hospital of Foshan, Foshan, China
- Chengguo Zhang
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Hu F, Yu S, Li J, Zhou W, Wang T, Huang X, Bao H, Cheng X. Association Between Hyperhomocysteinemia Combined with Metabolic Syndrome and Higher Prevalence of Stroke in Chinese Adults Who Have Elevated Blood Pressure. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e934100. [PMID: 35013090 PMCID: PMC8764874 DOI: 10.12659/msm.934100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Hyperhomocysteinemia (HHcy) and metabolic syndrome (MS) are established cardiovascular risk factors of stroke and are frequently associated with hypertension. However, studies on the association between HHcy combined with MS and stroke risk in hypertensive patients were absent. Material/Methods In 14 059 selected participants with elevated blood pressure, we assessed the prevalence of the MS and stroke. We defined HHcy as plasma total homocysteine >15 μmol/L. MS was defined according to the Chinese Diabetes Society (CDS) criterion. Multivariable analysis was used to examine the association of HHcy or (and) MS with stroke risk in different models. Results The prevalence rates of HHcy and MS were 49.96% and 42.21%, respectively. Patients with stroke had higher plasma total homocysteine levels and a higher prevalence of MS (P<0.001). Multivariable analyses indicated that HHcy and MS are independently associated with higher prevalence of stroke (adjusted-odds ratio (OR): 1.36, 95% CI 1.17 to 1.58, P<0.001; adjusted-OR: 1.68, 95% CI 1.44 to 1.96, P<0.001, respectively). Those with combined HHcy and MS had higher odds of stroke than those with isolated HHcy or MS (adjusted-OR: 1.78, 95% CI 1.47 to 2.15, P<0.001; adjusted-OR: 1.39, 95% CI 1.13 to 1.70, P=0.002, respectively). Conclusions HHcy combined with MS was associated with higher prevalence of stroke in Chinese adults with elevated blood pressure.
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Affiliation(s)
- Feng Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland).,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China (mainland)
| | - Shichao Yu
- Department of General Practice Medicine, Tuo Chuan Town Health Center, Wuyuan, Jiangxi, China (mainland)
| | - Juan Li
- The College of Pharmacy, Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Wei Zhou
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China (mainland).,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Tao Wang
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China (mainland).,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Xiao Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland).,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China (mainland).,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland).,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China (mainland).,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland).,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China (mainland).,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
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12
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Tu W, Yan F, Chao B, Ji X, Wang L. Status of hyperhomocysteinemia in China: results from the China Stroke High-risk Population Screening Program, 2018. Front Med 2021; 15:903-912. [PMID: 34893949 DOI: 10.1007/s11684-021-0871-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/29/2021] [Indexed: 12/31/2022]
Abstract
A nationwide survey was conducted from October 2018 to September 2019 to assess the prevalence of hyperhomocysteinemia (Hhcy) and its influencing factors in China. A standardized questionnaire was used to collect information. Hhcy was defined as the level of serum homocysteine (HCY) ⩾ 15.0µmol/L. The H-type hypertension (HHYP) was defined as hypertension with an elevated serum HCY 15.0µmol/L). Finally, 110 551 residents ⩾ 40 years of age from 31 provinces in the mainland of China were included. Overall, the median serum HCY level was 10.9µmol/L (interquartile range 7.9-15.1). A total of 28 633 participants (25.9%) were defined as Hhcy. The Hhcy prevalence ranged from 7.9% in Shanghai to 56.8% in Tianjin. The data showed that serum HCY levels were associated with age, male gender, cigarette smoking, hypertension, diabetes, ethnicity, endurance in exercise (inverse), and fruit and vegetable intake (inverse). In addition, 15 486 participants were defined as HHYP, and the rate was 14.0%. HHYP was an independent predictor of stroke with an adjusted odds ratio of 1.752 (95% CI 1.338-2.105). The geographical distribution pattern of the Hhcy epidemic reflects dynamic differences, and national strategies should be carried out to further improve the care of patients with Hhcy across China.
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Affiliation(s)
- Wenjun Tu
- Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300192, China.,The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, 100053, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Feng Yan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Baohua Chao
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, 100053, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
| | - Longde Wang
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, 100053, China.
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13
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Li C, Bu X, Liu Y. Effect of folic acid combined with pravastatin on arteriosclerosis in elderly hypertensive patients with lacunar infarction. Medicine (Baltimore) 2021; 100:e26540. [PMID: 34260532 PMCID: PMC8284717 DOI: 10.1097/md.0000000000026540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/19/2021] [Accepted: 06/14/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT This study aimed to assess the effect of folic acid combined with pravastatin on atherosclerosis-related indexes in elderly patients with hypertension complicated with lacunar cerebral infarction.A total of 134 elderly hypertensive patients with lacunar cerebral infarction were randomly divided into 3 groups using the random number table method. Group A, the folic acid group, had 45 cases and received low-dose folic acid (0.8 mg/d) treatment on the basis of antihypertensive treatment. Group B, the pravastatin group, had 45 cases and received pravastatin (20 mg/d) treatment on the basis of antihypertensive treatment. Group C, the folic acid combined with the pravastatin group, had 44 cases. Members of this group received pravastatin (20 mg/d) and low-dose folic acid (0.8 mg/d) based on antihypertensive treatment. Levels of folic acid, homocysteine (Hcy), tumor necrosis factor alpha (TNF-a), matrix metallopeptidase 9 (MMP-9), cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) were measured by ELISA before treatment in all 3 groups. Carotid intima-media thickness (IMT) was measured using ultrasound, and systolic and diastolic blood pressure were measured with a mercury column. After 8 weeks of treatment, the levels of folic acid, Hcy, TNF-a, MMP-9, TC, LDL-C, and systolic and diastolic blood pressure were compared among the 3 groups. IMT levels were measured at 12 weeks of treatment.After 8 weeks of treatment, compared with group B, patients in groups A and C had folic acid levels significantly higher than baseline levels, with significantly lower Hcy levels (both P < .05). Patients in group C presented significantly decreased TNF-a, MMP-9, TC, and LDL-C levels and systolic and diastolic blood pressure after 8 weeks of treatment, compared with those in groups A and B (both P < .05). These patients also showed significantly decreased IMT levels compared with those in the other groups (P < .05).Low-dose folic acid combined with pravastatin in elderly patients with lacunar cerebral infarction can reduce the level of homocysteine, improve the degree of carotid atherosclerosis, protect vascular endothelium, and reduce blood lipids and blood pressure, presenting better benefits than pravastatin alone.
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14
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Holmen M, Hvas AM, Arendt JFH. Hyperhomocysteinemia and Ischemic Stroke: A Potential Dose-Response Association-A Systematic Review and Meta-analysis. TH OPEN 2021; 5:e420-e437. [PMID: 34595387 PMCID: PMC8463136 DOI: 10.1055/s-0041-1735978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/19/2021] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose Previous studies suggest an association between increased homocysteine (Hcy) and risk of ischemic stroke. Yet, it remains unknown whether a dose-response association exists between Hcy levels and risk of ischemic stroke. Methods Systematic literature searches were performed in PubMed, Embase, Scopus, and Web of Science. Inclusion criteria were studies investigating ischemic stroke risk in an adult population with measured Hcy levels. We computed odds ratios (ORs) for a 5 µmol/L increase in Hcy levels using a random effects meta-analysis. Results In total, 108 studies met the inclusion criteria of which 22 were rated as high-quality studies, and 20 studies included a dose-response analysis. Hcy levels were analyzed either as a continuous or categorical variable. The majority of the studies found an increased risk of ischemic stroke when comparing the highest-to-lowest Hcy strata. A graded association was observed over the Hcy strata, indicating a dose-response association, with the most apparent effect when Hcy levels exceeded approximately 15 µmol/L. No studies explored a potential nonlinear association between Hcy levels and ischemic stroke. Six studies were included in a meta-analysis, showing an OR of 1.43 (95% confidence interval [CI]: 1.28-1.61) per 5 µmol/L increase in Hcy levels. Conclusion This review and meta-analysis indicate a dose-response association between Hcy levels and ischemic stroke. An evident increase in effect measures was observed when Hcy levels exceeded 15 µmol/L, indicating a nonlinear association between ischemic stroke and Hcy levels. This nonlinear association warrants further study. This study is registered with clinical trial ( https://www.crd.york.ac.uk/prospero/ ; unique identifier: CRD42019130371).
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Affiliation(s)
- Marte Holmen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Johan F. H. Arendt
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
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15
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Cui L, Lu P, Li S, Pan Y, Wang M, Li Z, Liao X, Wang Y. Relationship Among Homocysteine, Inflammation and Cognitive Impairment in Patients with Acute Ischemic Stroke and Transient Ischemic Attack. Neuropsychiatr Dis Treat 2021; 17:3607-3616. [PMID: 34924754 PMCID: PMC8674150 DOI: 10.2147/ndt.s333753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/27/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To investigate the associations among homocysteine (Hcy), inflammation and cognitive impairment in patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA). PATIENTS AND METHODS Patients included were enrolled from a subgroup of China National Stroke Registry-III (CNSR-III). We used a Chinese version of Montreal Cognitive Assessment (MoCA) to screen for cognitive impairment. We used high-sensitivity C-reactive protein (hsCRP) level to reflect the inflammatory status, which was assessed at baseline together with Hcy concentration. The primary outcome was the incidence of post-stroke cognitive impairment (PSCI) at 3 months after AIS and TIA. Multivariable logistic regression analysis was used to evaluate the correlation between Hcy and hsCRP, and their effects on cognition. RESULTS We enrolled 1466 patients with a median age of 62 (54-70) years old, including 895 (61.05%) patients with elevated Hcy levels, 466 (31.79%) with increased hsCRP concentrations, and 755 (51.50%) with PSCI. In the group of patients with hyperhomocysteinemia (HHcy), higher hsCRP levels were related to cognitive impairment, whether or not adjusted for multiple potential confounders (crude OR: 1.71,95% CI: 1.29-2.27, p < 0.01; adjusted OR: 1.42, 95% CI: 1.04-1.93, p = 0.03). No significant interactions for the impact on PSCI were observed in subgroups stratified by age, sex or Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification (P interaction > 0.05 for all). CONCLUSION High inflammatory levels increase the risk of cognitive impairment in HHcy patients after AIS and TIA.
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Affiliation(s)
- Lingyun Cui
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ping Lu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shiyu Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - YueSong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Mengxing Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Xiaoling Liao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
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16
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Xu S, Shi Q, Li B, Han L, Xu G, Peng X, Chen H, Dai S, Ma W, Wang C, Ma J. High MTHFR promoter methylation levels in men confer protection against ischemic stroke. Bosn J Basic Med Sci 2020; 20:477-486. [PMID: 32358951 PMCID: PMC7664794 DOI: 10.17305/bjbms.2020.4636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/29/2020] [Indexed: 02/05/2023] Open
Abstract
The MTHFR gene encodes methylenetetrahydrofolate reductase required for the metabolism of homocysteine (Hcy) - a previously reported independent risk factor for ischemic stroke (IS). In this study, we first aimed to clarify the association between DNA methylation levels in the MTHFR promoter and the risk of IS, followed by the analysis of potential interactions between environmental factors and DNA methylation levels that affect IS risk. We recruited 164 patients with hypertension and IS (case group) and 345 age-matched and sex-matched patients with hypertension only (control group). Demographic and clinical information was obtained using questionnaires, and blood samples were collected for biochemical analyses. Fluorescence quantitative methylation-specific PCR (qMSP) was used to detect MTHFR promoter methylation levels. A logistic regression analysis was performed to determine the relationship between environmental factors, MTHFR promoter methylation levels, and IS risk. We finally generated a receiver operating characteristic curve to determine whether MTHFR promoter methylation levels can predict IS. The mean MTHFR methylation levels in the case group (8.10 ± 6.14) were significantly lower than those in the control group (17.44 ± 3.16; p < 0.05). MTHFR promoter methylation levels were also lower in patients with plasma Hcy levels ≥15 μmol/L (10.65 ± 4.05) than in those with Hcy levels <15 μmol/L (16.74 ± 4.26, p < 0.001). Finally, we found that MTHFR hypermethylation is a protective factor for IS, particular in men (OR in men: 0.07; 95% CI: 0.02-0.16; p < 0.001). Further, sex and MTHFR promoter methylation levels exhibited a preliminary interaction effect on IS risk. These results indicate that MTHFR promoter methylation status might have diagnostic value in IS.
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Affiliation(s)
- Shan Xu
- Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Qianping Shi
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Bo Li
- Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Liyuan Han
- Department of Preventive Medicine, School of Medicine, Ningbo University, Ningbo, China
| | - Guodong Xu
- Medical Record Statistics Room, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Xiaolin Peng
- Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Hongen Chen
- Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Shuhong Dai
- Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Wancheng Ma
- Luohu Center for Chronic Disease Control, Shenzhen, China
| | - Changyi Wang
- Nanshan Center for Chronic Disease Control, Shenzhen, China
- Corresponding authors: Changyi Wang and Jianping Ma, Nanshan Center for Chronic Disease Control, 5 Huaming Road, Shenzhen, China. E-mail:
| | - Jianping Ma
- Nanshan Center for Chronic Disease Control, Shenzhen, China
- Corresponding authors: Changyi Wang and Jianping Ma, Nanshan Center for Chronic Disease Control, 5 Huaming Road, Shenzhen, China. E-mail:
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17
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Lv P, Zheng Y, Huang J, Ke J, Zhang H. Association of Apolipoprotein E Gene Polymorphism with Ischemic Stroke in Coronary Heart Disease Patients Treated with Medium-intensity Statins. Neuropsychiatr Dis Treat 2020; 16:2459-2466. [PMID: 33122909 PMCID: PMC7591236 DOI: 10.2147/ndt.s265194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/24/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To study the association of apolipoprotein E(APOE) gene polymorphism with ischemic stroke (IS) in coronary heart disease (CHD) patients treated with medium-intensity statins. METHODS The retrospective study was performed on 662 samples including 169 CHD subjects complicated with IS, 296 subjects with CHD, and 197 control subjects. The APOE gene was obtained from case files. Univariable and multivariable logistic regression analyses were utilized to recognize the possible risks of CHD and IS. RESULTS The frequency of ε3-ε4 genotype was increased in the CHD group (p=0.013) and CHD-IS group (p=0.001), the frequency of ε4 allele was also increased in the CHD group (p=0.047) and the CHD-IS group (p=0.009) compared with control group. ε3-ε4 genotype was the independent risk for CHD and CHD-IS after adjusting for traditional risk factors with adjusted odds ratio (AOR) 2.210, 95%CI: 1.263-3.867, p=0.005) and (AOR 2.794, 95%CI: 1.539-5.072, p=0.002). The ε4 allele was also significantly associated with CHD (AOR 2.126, 95%CI: 1.265-3.575,=0.004) and CHD-IS (AOR 2.740, 95%CI: 1.569-4.784, p=0.001). CONCLUSION These results demonstrated that ε4 allele influenced the development of CHD with or without IS, especially for the genotype of ε3-ε4. CHD patients carrying the ε3-ε4 genotype and the ε4 allele were significantly associated with the incidence of IS, even if medium-intensity statins had been used.
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Affiliation(s)
- Ping Lv
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi330006, People’s Republic of China
| | - Yaofu Zheng
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi330006, People’s Republic of China
| | - Jun Huang
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi330006, People’s Republic of China
| | - Junsong Ke
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi330006, People’s Republic of China
| | - Hongyu Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi330006, People’s Republic of China
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18
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Liu Y, Yang J, Jiang P, Wang S, Wang M, Wang M, Guo T, Liu J. DAPT score: predictive model of dual-antiplatelet therapy for acute cerebral infarction. Neurol Sci 2020; 42:681-688. [PMID: 32656712 DOI: 10.1007/s10072-020-04552-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/01/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This article analyzes factors which affect the prognosis of acute cerebral infarction (ACI) patients receiving a course of antiplatelet therapy with aspirin and (or) clopidogrel for 14 days and proposes a simple grading scale to predict the clinical effectiveness of these drugs. METHODS We evaluated the association between ACI and risk factor (univariate analysis) on at day 14 post admission. Factors which potentially affected the 14-day prognosis of the patients were identified by logistic regression. A clinical grading scale, the DAPT score, was developed by weighing the independent predictors based on these factors. RESULTS It is revealed that the factors which affected 14 days prognosis univariate analysis included age ≥ 50 years (P = 0.007), diabetes (P = 0.017), hypertension (P ≤ 0.001), hyperhomocysteinemia (P = 0.001), and ipsilateral carotid artery stenosis ≥ 50% (P = 0.019). Logistic regression also revealed that the factors which affected 14 days prognosis included age ≥ 50 years (P = 0.007), hypertension (P ≤ 0.001), hyperhomocysteinemia (P = 0.001), and ipsilateral carotid artery stenosis ≥ 50% (P = 0.014).The assigned values of age ≥ 50 years, Grade 1 hypertension, Grade 2 hypertension, Grade 3 hypertension, hyperhomocysteinemia, and ipsilateral carotid artery stenosis ≥ 50% were 1, 1, 2, 3, 1, and 1, respectively. We named this score (DAPT score) and it ranged between 0 and 6. Using 3 as a cutoff, the sensitivity was 90.6% and the specificity was 63.3%. CONCLUSIONS The DAPT Score might be useful to for identifying with ACI who are suitable to receive aspirin combined with clopidogrel. Future large-scale, multi-center prospective studies are necessary.
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Affiliation(s)
- Yang Liu
- Ningxia Medical University, Yinchuan, 750004, China.,Gansu Provincial Hospital, 204 West Donggang R.D, Lanzhou, 730000, China
| | - Jia Yang
- Ningxia Medical University, Yinchuan, 750004, China.,Gansu Provincial Hospital, 204 West Donggang R.D, Lanzhou, 730000, China
| | - Panpan Jiang
- Ningxia Medical University, Yinchuan, 750004, China.,Gansu Provincial Hospital, 204 West Donggang R.D, Lanzhou, 730000, China
| | - Shan Wang
- Gansu Province Hospital Rehabilitation Center, Lanzhou, 730000, China
| | - Mingming Wang
- Gansu Provincial Hospital, 204 West Donggang R.D, Lanzhou, 730000, China
| | - Mayan Wang
- Ningxia Medical University, Yinchuan, 750004, China.,Gansu Provincial Hospital, 204 West Donggang R.D, Lanzhou, 730000, China
| | - Tiankang Guo
- Gansu Provincial Hospital, 204 West Donggang R.D, Lanzhou, 730000, China.
| | - Jianxiong Liu
- Gansu Provincial Hospital, 204 West Donggang R.D, Lanzhou, 730000, China.
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19
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Zhang Z, Gu X, Fang X, Tang Z, Guan S, Liu H, Wu X, Wang C, Zhao Y. Homocysteine and the Risk of Cardiovascular Events and All-Cause Death in Elderly Population: A Community-Based Prospective Cohort Study. Ther Clin Risk Manag 2020; 16:471-481. [PMID: 32547044 PMCID: PMC7250705 DOI: 10.2147/tcrm.s239496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background The association between homocysteine and cardiovascular diseases (CVD) and all-cause death was inconclusive. A community-based prospective cohort study was carried out in Beijing to evaluate this association in elderly population for more effective clinical prediction and primary prevention of CVD. Patients and Methods Participants were randomly selected from Beijing, China. Questionnaire survey, physical examinations, and laboratory tests were carried out to collect baseline information and investigate clinical characteristics. Each participant was predetermined to be followed by 5 years. CVD events and death were collected as primary variables. A Cox regression analysis was performed to assess the risk of CVD events, CVD death, and all-cause death contributed by homocysteine as well as some other risk factors. Results A total of 1257 participants with an average age of 69.16 years were enrolled in this study. After adjusting for confounders, the hazard ratios (HRs) and 95% confidence intervals of CVD event, CVD death, and all-cause death caused by intermediate-to-severe hyperhomocysteinemia as compared with normal homocysteine levels were 1.68 (95% CI 1.06–2.67), 1.97 (95% CI 0.95–4.29) and 2.02 (95% CI 1.26–3.24), respectively. Intermediate-to-severe hyperhomocysteinemia increased the risks of CVD event (HR 2.07, 95% CI 1.01–4.26) and all-cause death (HR 3.08, 95% CI 1.56–6.07) among male participants. However, the positive association was not statistically significant among female participants (HR 1.59, 95% CI 0.83–3.04 for CVD event and HR 0.90, 95% CI 0.52–6.07 for all-cause death). Every 5μmol/L increment in homocysteine concentration was shown to be associated with a 4% (HR 1.04, 95% CI 1.01–1.07) and 5% (HR 1.05, 95% CI 1.01–1.07) higher risk of CVD events and all-cause death in all participants. There was no significant association between moderate hyperhomocysteinemia and the risk of the CVD events and all-cause death. Conclusion Intermediate-to-severe hyperhomocysteinemia was significantly associated with CVD events and all-cause death in elderly population without a history of ischemia or congestive heart failure (CHF). The positive association was pronounced among males.
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Affiliation(s)
- Zhongying Zhang
- Geriatric Department, Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiang Gu
- Medical Affair Department, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xianghua Fang
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhe Tang
- Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shaochen Guan
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hongjun Liu
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaoguang Wu
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chunxiu Wang
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yan Zhao
- Education Department, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
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Bogiatzi C, Azarpazhooh MR, Spence JD. Choosing the right therapy for a patient with asymptomatic carotid stenosis. Expert Rev Cardiovasc Ther 2020; 18:53-63. [PMID: 32043917 DOI: 10.1080/14779072.2020.1729127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Most patients with asymptomatic carotid stenosis (ACS) now have a lower risk with intensive medical therapy than with stenting (CAS) or endarterectomy (CEA); the annual risk of stroke or death with intensive medical therapy is ~ 0.5%, vs. a periprocedural risk with CAS of ~ 2.5-4.1% with CAS, and ~ 1.4-1.8% with CEA. The excess risk of CAS is greater in older patients.Areas covered: Discussed are the need for intensive medical therapy, the nature of intensive medical therapy, approaches to identifying the few patients with ACS who could benefit from CEA or CAS, and which patients would be better suited to CEA vs. CAS.Expert opinion: All patients with ACS are at high risk of cardiovascular events, soshould receive intensive medical therapy including lifestyle modification, intensive lipid-lowering, B vitamins to lower homocysteine (using methylcobalamin rather than cyanocobalamin), and appropriate antithrombotic therapy. High-risk patients who could benefit from intervention can be identified by clinical and imaging features including transcranial Doppler embolus detection, ulceration, intraplaque hemorrhage, reduced cerebrovascular reserve, plaque echolucency, silent infarction on brain imaging, and progression of stenosis. Most patients whose risk of stroke warrants intervention would be better treated with CEA than with CAS.
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Affiliation(s)
- Chrysi Bogiatzi
- Department of Neurology, McMaster University, Hamilton, Ontario, Canada
| | - M Reza Azarpazhooh
- Department of Clinical Neurological Sciences (Neurology), Western University, London, Ontario, Canada
| | - J David Spence
- Departments of Clinical Neurological Sciences (Neurology) and Internal Medicine (Clinical Pharmacology), Robarts Research Institute, London, Ontario, Canada
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21
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Yu L, Yang L, Li Y, Yang S, Gu H, Hu W, Gao S. Hyperhomocysteinemia can predict the severity of white matter hyperintensities in elderly lacunar infarction patients. Int J Neurosci 2019; 130:231-236. [PMID: 31744348 DOI: 10.1080/00207454.2019.1667795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ling Yu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China
| | - Lei Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China
| | - Yue Li
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China
| | - Shuna Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China
| | - Hua Gu
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China
| | - Wenli Hu
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China
| | - Shan Gao
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China
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22
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Wang S, Huang Z, Li W, He S, Wu H, Zhu J, Li R, Liang Z, Chen Z. IL‑37 expression is decreased in patients with hyperhomocysteinemia and protects cells from inflammatory injury by homocysteine. Mol Med Rep 2019; 21:371-378. [PMID: 31746381 DOI: 10.3892/mmr.2019.10804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 09/04/2019] [Indexed: 11/06/2022] Open
Abstract
As a novel anti‑inflammatory cytokine of the interleukin (IL)‑1 family, IL‑37 protects the human body from diseases characterized by excessive inflammation. The pathologic process of hyperhomocysteinemia (hHcy) is accompanied by persistent inflammation. However, little is known regarding the role of IL‑37 in hHcy. In the present study, the levels of cytokines including IL‑37, IL‑1β, IL‑6 and tumor necrosis factor‑α in the supernatant were detected by ELISA. mRNA and protein expression were detected by Reverse transcription‑quantitative PCR and western blotting, respectively. LDH level was determined by ELISA and the cell viability was detected through CCK‑8 kit. In the present study, mean serum IL‑37 levels of patients with hHcy were 32.3% lower than those of controls (P<0.01). In peripheral blood mononuclear cells (PBMCs) from patients with hHcy, mean IL‑37 mRNA expression was 73.5% lower (P<0.01) and IL‑37 protein expression was 77.7% lower compared with that of healthy controls (P<0.01). Furthermore, the results demonstrated that exogenous homocysteine (Hcy) stimulation markedly downregulated the mRNA and protein expression levels of IL‑37 in PBMCs in vitro. In 293T cells, overexpression of IL‑37 restored the cell viability impaired by Hcy, and reduced the release of lactate dehydrogenase and the proinflammatory cytokines IL‑1β, IL‑6 and tumor necrosis factor‑α. In conclusion, IL‑37 was downregulated by Hcy in vivo and in vitro, and IL‑37 exhibited a protective role against cell injury induced by Hcy.
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Affiliation(s)
- Sen Wang
- Key Laboratory for Medical Molecular Diagnostics of Guangdong Province, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Zhen Huang
- Longgang Central Hospital, Shenzhen, Guangdong 518116, P.R. China
| | - Wenrui Li
- Eighth People's Hospital of Dongguan City, Dongguan, Guangdong 523321, P.R. China
| | - Suhui He
- Key Laboratory for Medical Molecular Diagnostics of Guangdong Province, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Hongmei Wu
- Longgang Central Hospital, Shenzhen, Guangdong 518116, P.R. China
| | - Jiandong Zhu
- Key Laboratory for Medical Molecular Diagnostics of Guangdong Province, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Rumeng Li
- Key Laboratory for Medical Molecular Diagnostics of Guangdong Province, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Zhuangyan Liang
- Key Laboratory for Medical Molecular Diagnostics of Guangdong Province, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Zhangquan Chen
- Key Laboratory for Medical Molecular Diagnostics of Guangdong Province, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
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Huang J, Yang J, Li J, Chen Z, Guo X, Huang S, Gu L, Su L. Association of long noncoding RNA H19 polymorphisms with the susceptibility and clinical features of ischemic stroke in southern Chinese Han population. Metab Brain Dis 2019; 34:1011-1021. [PMID: 31041585 DOI: 10.1007/s11011-019-00417-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/07/2019] [Indexed: 01/10/2023]
Abstract
Stroke is the leading cause of death in China. Previous studies have demonstrated that long noncoding RNAs play important roles in ischemic stroke (IS). This study aimed to investigate long noncoding RNA H19 (lncRNA H19) expression in IS cases and the association between lncRNA H19 variants and IS risk and IS-related risk factors. A total of 550 IS cases and 550 controls were recruited for this study. LncRNA H19 expression was detected using quantitative real-time polymerase chain reaction. Genotyping was conducted by the Sequenom MassARRAY technology. LncRNA H19 level in peripheral blood of IS cases was significantly upregulated compared with healthy controls (P = 0.046). No significant association was observed between lncRNA H19 rs217727 and rs4929984 polymorphisms with IS risk in all genetic models, and rs217727-rs4929984 haplotypes are not associated with IS susceptibility. Further meta-analysis also implied that the rs217727 and rs4929984 polymorphisms were not associated with IS in Chinese population. However, rs4929984 is significantly associated with the diastolic blood pressure level of IS patients (additive model: Padj = 0.007; dominant model: Padj = 0.013), whereas rs217727 is associated with international normalized ratio (additive model: Padj = 0.019; recessive model: Padj = 0.004), prothrombin time activity level (additive model: Padj = 0.026; recessive model: Padj = 0.004), and homocysteine level (recessive model: Padj = 0.048) in patients with IS. Our findings suggest that lncRNA H19 level may affect the occurrence of IS, and lncRNA H19 variants may influence blood pressure, coagulation function, and homocysteine metabolism of patients with IS in the southern Chinese Han population.
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Affiliation(s)
- Jiao Huang
- School of Public Health of Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Jialei Yang
- School of Public Health of Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Jinhong Li
- Department of Internal Neurology, First Affiliated Hospital, Guangxi University of Chinese Medicine, 89-9 Dongge Road, Nanning, 530023, Guangxi, China
| | - Zhaoxia Chen
- School of Public Health of Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Xiaojing Guo
- School of Public Health of Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Siyun Huang
- Department of Internal Neurology, First Affiliated Hospital, Guangxi University of Chinese Medicine, 89-9 Dongge Road, Nanning, 530023, Guangxi, China
| | - Lian Gu
- Department of Internal Neurology, First Affiliated Hospital, Guangxi University of Chinese Medicine, 89-9 Dongge Road, Nanning, 530023, Guangxi, China.
| | - Li Su
- School of Public Health of Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China.
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24
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Ahmed S, Bogiatzi C, Hackam DG, Rutledge AC, Sposato LA, Khaw A, Mandzia J, Azarpazhoo MR, Hachinski V, Spence JD. Vitamin B 12 deficiency and hyperhomocysteinaemia in outpatients with stroke or transient ischaemic attack: a cohort study at an academic medical centre. BMJ Open 2019; 9:e026564. [PMID: 30670531 PMCID: PMC6347886 DOI: 10.1136/bmjopen-2018-026564] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/02/2018] [Accepted: 12/05/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE We sought to assess the current magnitude of the opportunity for secondary stroke prevention with B vitamins. DESIGN A cohort study. SETTING The Urgent TIA (Transient Ischaemic Attack) Clinic at an academic medical centre. MAIN OUTCOME MEASURES We assessed the prevalence of biochemical vitamin B12 deficiency (B12Def, serum B12 <156 pmol/L), hyperhomocysteinaemia (HHcy; plasma total homocysteine [tHcy] >14 µmol/L) and metabolic B12 deficiency (MetB12Def, serum B12 <258 pmol/L and HHcy) between 2002 and 2017, by age group and by stroke subtype. RESULTS Data were available in 4055 patients. B12Def was present in 8.2% of patients overall; it declined from 10.9% of patients referred before 2009 to 5.4% thereafter (p=0.0001). MetB12Def was present in 10.6% of patients, and HHcy was present in 19.1% of patients. Among the patients aged ≥80 years, MetB12Def was present in 18.1% and HHcy in 35%. Among the 3410 patients whose stroke subtype was determined, HHcy was present in 18.4% of patients: 23.3% of large artery atherosclerosis, 18.1% of cardioembolic, 16.3% of small vessel disease, 10.8% of other unusual aetiologies and 13.6% of undetermined subtypes (p=0.0001). CONCLUSIONS Despite a decline in our referral area since 2009, B12Def, MetB12Def and HHcy remain common in patients with stroke/TIA. Because these conditions are easily treated and have serious consequences, all patients with stroke/TIA should have their serum B12 and tHcy measured.
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Affiliation(s)
- Shamon Ahmed
- University of British Columbia Medical School, Vancouver, British Columbia, Canada
| | | | - Daniel G Hackam
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- University Hospital, London, Ontario, Canada
| | - Angela C Rutledge
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
- Victoria Hospital, London, Ontario, Canada
| | - Luciano A Sposato
- University Hospital, London, Ontario, Canada
- Division of Neurology, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
- Dementia and Heart Disease Lab, Western University, London, Ontario, Canada
| | - Alexander Khaw
- University Hospital, London, Ontario, Canada
- Division of Neurology, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Jennifer Mandzia
- University Hospital, London, Ontario, Canada
- Division of Neurology, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Mahmoud Reza Azarpazhoo
- University Hospital, London, Ontario, Canada
- Division of Neurology, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Vladimir Hachinski
- University Hospital, London, Ontario, Canada
- Division of Neurology, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - J David Spence
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- University Hospital, London, Ontario, Canada
- Division of Neurology, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
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25
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Nam KW, Kwon HM, Jeong HY, Park JH, Kwon H, Jeong SM. Serum homocysteine level is related to cerebral small vessel disease in a healthy population. Neurology 2019; 92:e317-e325. [PMID: 30602466 DOI: 10.1212/wnl.0000000000006816] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/27/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between serum total homocysteine (tHcy) levels and cerebral small vessel disease (cSVD) in a healthy population. METHODS We included consecutive participants who visited our department for health checkups between 2006 and 2013. We rated white matter hyperintensity volumes using both the Fazekas score and semiautomated quantitative methods. We also evaluated lacunes, cerebral microbleeds, and enlarged perivascular spaces (EPVS), which are involved in cSVD. To assess the dose-dependent relationship between tHcy and cSVD parameters, we scored the burdens of each radiologic marker of cSVD. RESULTS A total of 1,578 participants were included (age 55 ± 8 years, male sex 57%). In the multivariable analysis, tHcy remained an independent predictor of the white matter hyperintensity volume (B = 0.209; 95% confidence interval [CI] = 0.033-0.385, p = 0.020), presence of cerebral microbleeds (adjusted odds ratio = 2.800; 95% CI = 1.104-7.105, p = 0.030), and moderate to severe EPVS (adjusted odds ratio = 5.906; 95% CI = 3.523-9.901, p < 0.001) after adjusting for confounders. Furthermore, tHcy had positive associations with periventricular Fazekas score (p = 0.001, p for trend <0.001), subcortical Fazekas score (p = 0.003, p for trend = 0.005), and moderate to severe EPVS lesion burden (p < 0.001, p for trend <0.001) in a dose-dependent manner. CONCLUSIONS Serum tHcy level is correlated with cSVD development in a dose-dependent manner. These findings provide us with clues for further studies of the pathophysiology of cSVD.
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Affiliation(s)
- Ki-Woong Nam
- From the Departments of Neurology (K.-W.N., H.-Y.J.) and Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine and Seoul National University; and Department of Neurology (H.-M.K.), Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyung-Min Kwon
- From the Departments of Neurology (K.-W.N., H.-Y.J.) and Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine and Seoul National University; and Department of Neurology (H.-M.K.), Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
| | - Han-Yeong Jeong
- From the Departments of Neurology (K.-W.N., H.-Y.J.) and Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine and Seoul National University; and Department of Neurology (H.-M.K.), Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jin-Ho Park
- From the Departments of Neurology (K.-W.N., H.-Y.J.) and Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine and Seoul National University; and Department of Neurology (H.-M.K.), Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
| | - Hyuktae Kwon
- From the Departments of Neurology (K.-W.N., H.-Y.J.) and Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine and Seoul National University; and Department of Neurology (H.-M.K.), Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Su-Min Jeong
- From the Departments of Neurology (K.-W.N., H.-Y.J.) and Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine and Seoul National University; and Department of Neurology (H.-M.K.), Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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26
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A risk score for carotid plaque as an assessment risk of cardiovascular risk among patients with hypertension. ACTA ACUST UNITED AC 2018; 12:833-840. [PMID: 30482471 DOI: 10.1016/j.jash.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/12/2018] [Accepted: 11/04/2018] [Indexed: 11/23/2022]
Abstract
This study aimed to describe the status of carotid plaques and develop a simple scoring system to predict the risk of carotid lesions in patients with hypertension. Basic testing for carotid plaques was carried out and used for risk score development (the training dataset, n = 2665) and validation (the test dataset, n = 1333). Independent predictors of carotid plaques from the multivariate model were assigned integer weights based on their coefficients and incorporated into a risk score. The discriminant ability of the score was tested by receiver operating characteristic analysis using the test dataset. A total of 1346 of 2665 patients were examined for carotid plaques, which were more frequent in men than in women, and increased with age. The final model included eight significant variables, and these variables were then used to develop a risk score for the prediction of carotid plaques. Receiver operating characteristic analysis demonstrated good discriminant power with a C-statistic of 0.732 (95% confidence interval: 0.713-0.751) and good calibration across quantiles of observed predicted risk (74.6%). We developed a simple risk score for the prediction of carotid plaques based on eight variables. The prediction model showed good discriminant power and calibration.
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27
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Xie JC, Lin YY, Liu XH, Zhao YC, Ma XY, Yu J, Liu XY, Zhao YX. Homocysteine is Associated with Exaggerated Morning Blood Pressure Surge in Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2018; 27:2650-2656. [PMID: 29960667 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Considerable researches suggest that high level of homocysteine (Hcy) is associated with the risk of ischemic stroke. Ambulatory blood pressure monitoring (ABPM) parameters have also been confirmed associated with cardio-cerebrovascular events. However, the relationship between Hcy and ABPM parameters remains unclear in patients with acute ischemic stroke. In this study, we aim to investigate the association between Hcy level and ABPM parameters in patients with acute ischemic stroke. METHODS We enrolled 60 patients with acute ischemic stroke who received ABPM. We calculated ABPM parameters like morning blood pressure surge (MBPS), ambulatory arterial stiffness index, blood pressure variability, and night dipping patterns. RESULTS Multivariate logistic regression analysis indicated that patients in the top quartile of Hcy level tended to have a higher level of prewaking and sleep-trough MBPS compared with patients in the lower 3 quartiles after adjusted for age and gender (P = .028 and P = .030, respectively). When treating Hcy as a continuous variable, the linear regression showed the association between Hcy level and both MBPS parameters remained significant (prewaking MBPS, r = .356, P = .022; sleep-trough MBPS, r = .365, P = .017, respectively). However, there is no association between Hcy level and ambulatory arterial stiffness index, blood pressure variability or night dipping patterns (P = .635, P = .348 and P = .127 respectively). CONCLUSIONS There is a relationship between the 2 major cerebrovascular risk factors: MBPS and Hcy.
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Affiliation(s)
- Jun-Chao Xie
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Ying-Ying Lin
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xiao-Hui Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yi-Chen Zhao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xiao-Ye Ma
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Jia Yu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xue-Yuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
| | - Yan-Xin Zhao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
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28
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Guo G, Sun W, Liu G, Zheng H, Zhao J. Comparison of oxidative stress biomarkers in hypertensive patients with or without hyperhomocysteinemia. Clin Exp Hypertens 2017; 40:262-266. [PMID: 28920709 DOI: 10.1080/10641963.2017.1368535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Gang Guo
- Emergency Department, Tongji Hospital Affiliated to Tongji University, Shanghai, China
| | - Wenjiang Sun
- Rehabilitation Department, Tongji Hospital Affiliated to Tongji University, Shanghai, China
| | - Guanghui Liu
- Endocrine Department, Tongji Hospital Affiliated to Tongji University, Shanghai, China
| | - Huan Zheng
- Geriatrics Department, Tongji Hospital Affiliated to Tongji University, Shanghai, China
| | - Jiasheng Zhao
- Endocrine Department, Tongji Hospital Affiliated to Tongji University, Shanghai, China
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29
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Udhayabanu T, Karthi S, Mahesh A, Varalakshmi P, Manole A, Houlden H, Ashokkumar B. Adaptive regulation of riboflavin transport in heart: effect of dietary riboflavin deficiency in cardiovascular pathogenesis. Mol Cell Biochem 2017; 440:147-156. [PMID: 28836047 DOI: 10.1007/s11010-017-3163-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/16/2017] [Indexed: 01/09/2023]
Abstract
Deficiency or defective transport of riboflavin (RF) is known to cause neurological disorders, cataract, cardiovascular anomalies, and various cancers by altering the biochemical pathways. Mechanisms and regulation of RF uptake process is well characterized in the cells of intestine, liver, kidney, and brain origin, while very little is known in the heart. Hence, we aimed to understand the expression and regulation of RF transporters (rRFVT-1 and rRFVT-2) in cardiomyocytes during RF deficiency and also investigated the role of RF in ischemic cardiomyopathy and mitochondrial dysfunction in vivo. Riboflavin uptake assay revealed that RF transport in H9C2 is (1) significantly higher at pH 7.5, (2) independent of Na+ and (3) saturable with a Km of 3.746 µM. For in vivo studies, male Wistar rats (110-130 g) were provided riboflavin deficient food containing 0.3 ± 0.05 mg/kg riboflavin for 7 weeks, which resulted in over expression of both RFVTs in mRNA and protein level. RF deprivation resulted in the accumulation of cardiac biomarkers, histopathological abnormalities, and reduced mitochondrial membrane potential which evidenced the key role of RF in the development of cardiovascular pathogenesis. Besides, adaptive regulation of RF transporters upon RF deficiency signifies that RFVTs can be considered as an effective delivery system for drugs against cardiac diseases.
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Affiliation(s)
- Tamilarasan Udhayabanu
- Department of Genetic Engineering, School of Biotechnology, Madurai Kamaraj University, Madurai, 625021, India
| | - Sellamuthu Karthi
- Department of Genetic Engineering, School of Biotechnology, Madurai Kamaraj University, Madurai, 625021, India
| | - Ayyavu Mahesh
- Centre for Excellence in Genomics Science, School of Biological Sciences, Madurai Kamaraj University, Madurai, 625021, India
| | - Perumal Varalakshmi
- Department of Molecular Microbiology, School of Biotechnology, Madurai Kamaraj University, Madurai, 625021, India
| | - Andreea Manole
- Department of Molecular Neuroscience and Neurogenetics Laboratory, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Henry Houlden
- Department of Molecular Neuroscience and Neurogenetics Laboratory, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Balasubramaniem Ashokkumar
- Department of Genetic Engineering, School of Biotechnology, Madurai Kamaraj University, Madurai, 625021, India.
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Zhao M, Wang X, He M, Qin X, Tang G, Huo Y, Li J, Fu J, Huang X, Cheng X, Wang B, Hou FF, Sun N, Cai Y. Homocysteine and Stroke Risk: Modifying Effect of Methylenetetrahydrofolate Reductase C677T Polymorphism and Folic Acid Intervention. Stroke 2017; 48:1183-1190. [PMID: 28360116 DOI: 10.1161/strokeaha.116.015324] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/25/2016] [Accepted: 02/15/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Elevated blood homocysteine concentration increases the risk of stroke, especially among hypertensive individuals. Homocysteine is largely affected by the methylenetetrahydrofolate reductase C677T polymorphism and folate status. Among hypertensive patients, we aimed to test the hypothesis that the association between homocysteine and stroke can be modified by the methylenetetrahydrofolate reductase C677T polymorphism and folic acid intervention. METHODS We analyzed the data of 20 424 hypertensive adults enrolled in the China Stroke Primary Prevention Trial. The participants, first stratified by methylenetetrahydrofolate reductase genotype, were randomly assigned to receive double-blind treatments of 10-mg enalapril and 0.8-mg folic acid or 10-mg enalapril only. The participants were followed up for a median of 4.5 years. RESULTS In the control group, baseline log-transformed homocysteine was associated with an increased risk of first stroke among participants with the CC/CT genotype (hazard ratio, 3.1; 1.1-9.2), but not among participants with the TT genotype (hazard ratio, 0.7; 0.2-2.1), indicating a significant gene-homocysteine interaction (P=0.008). In the folic acid intervention group, homocysteine showed no significant effect on stroke regardless of genotype. Consistently, folic acid intervention significantly reduced stroke risk in participants with CC/CT genotypes and high homocysteine levels (tertile 3; hazard ratio, 0.73; 0.55-0.97). CONCLUSIONS In Chinese hypertensive patients, the effect of homocysteine on the first stroke was significantly modified by the methylenetetrahydrofolate reductase C677T genotype and folic acid supplementation. Such information may help to more precisely predict stroke risk and develop folic acid interventions tailored to individual genetic background and nutritional status. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00794885.
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Affiliation(s)
- Min Zhao
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.)
| | - Xiaobin Wang
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.)
| | - Mingli He
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.)
| | - Xianhui Qin
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.)
| | - Genfu Tang
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.)
| | - Yong Huo
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.)
| | - Jianping Li
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.)
| | - Jia Fu
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.)
| | - Xiao Huang
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.)
| | - Xiaoshu Cheng
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.)
| | - Binyan Wang
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.)
| | - Fan Fan Hou
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.)
| | - Ningling Sun
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.).
| | - Yefeng Cai
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (M.Z., X.Q., B.W., F.F.H.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.); Department of Neurology, First People's Hospital, Lianyungang, China (M.H.); Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H., J.L.); Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.); Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Jiangxi, China (X.H., X.C.); Hypertension Research Laboratory of Heart Center, Peking University People's Hospital, Beijing, China (N.S.); and Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (M.Z., Y.C.).
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31
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Xu B, Kong X, Xu R, Song Y, Liu L, Zhou Z, Gu R, Shi X, Zhao M, Huang X, He M, Fu J, Cai Y, Li P, Cheng X, Wu C, Chen F, Zhang Y, Tang G, Qin X, Wang B, Xue H, Chen Y, Tian Y, Sun N, Cui Y, Hou FF, Li J, Huo Y. Homocysteine and all-cause mortality in hypertensive adults without pre-existing cardiovascular conditions: Effect modification by MTHFR C677T polymorphism. Medicine (Baltimore) 2017; 96:e5862. [PMID: 28225483 PMCID: PMC5569412 DOI: 10.1097/md.0000000000005862] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Previous studies support an association between elevated total homocysteine (tHcy) levels and increased all-cause mortality. However, few prospective studies have examined this association in hypertensive patients, and/or tested any effect modification by the methylene tetrahydrofolate reductase (MTHFR) C677T genotype. METHODS This was a post hoc analysis of the China Stroke Primary Prevention Trial. Serum tHcy and folate were measured at baseline. Individual MTHFR C677T genotype (CC, CT, and TT) was determined. Evidence for death included death certificates or home visits. Cumulative hazards of all-cause mortality by tHcy quartiles were estimated using the Kaplan-Meier method, and group differences were compared by log-rank tests. Hazard ratios (HRs) and 95% confidence intervals were estimated by Cox proportional-hazard regression models, adjusting for age, sex, baseline folate, vitamin B12, blood pressure, body mass index, smoking and alcohol drinking status, study center, total cholesterol, triglycerides, high-density lipoprotein cholesterol, fasting glucose, creatinine, and treatment group. Potential effect modification by the MTHFR genotype on the relationship between tHcy and all-cause mortality was tested. RESULTS The analyses included 20,424 hypertensive patients (41% males) without a history of myocardial infarction or stroke. Baseline mean age (SD) was 60 ± 7.5 years and mean (SD) serum tHcy was 14.5 ± 8.4 μmol/L. After a mean follow-up period of 4.5 years, there were 612 (3%) all-cause deaths. Kaplan-Meier survival curves revealed a graded relationship between tHcy quartiles and all-cause mortality. The HRs, using the lowest quartile as the reference, were 1.2, 1.2, and 1.5 in Q2, Q3, and Q4, respectively. A linear trend test, using natural log-transformed tHcy, resulted in an HR of 1.5 (95% confidence interval 1.2-1.9, P < .001) after adjustment for lifestyle and health-related variables. Whereas the MTHFR genotype alone had little effect on mortality, it significantly modified the tHcy-mortality association, which was much stronger in the CC/CT genotype than in the TT genotype (P for interaction < 0.05). CONCLUSIONS Among Chinese hypertensive patients without cardiovascular comorbidities, elevated tHcy was a significant risk marker for death from all causes, and the association was subject to effect modification by MTHFR genotypes. If confirmed that tHcy and MTHFR genotypes may serve as useful biomarkers for mortality risk assessment and targeted intervention.
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Affiliation(s)
- Benjamin Xu
- Department of Cardiology, Peking University First Hospital, Beijing
| | - Xiangyi Kong
- Department of Cardiology, Peking University First Hospital, Beijing
| | - Richard Xu
- Department of Cardiology, Peking University First Hospital, Beijing
| | - Yun Song
- National Clinical Research Study Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Lishun Liu
- Institute for Biomedicine, Anhui Medical University
| | - Ziyi Zhou
- Institute for Biomedicine, Anhui Medical University
| | - Rui Gu
- Institute for Biomedicine, Anhui Medical University
| | - Xiuli Shi
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei
| | - Min Zhao
- National Clinical Research Study Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Xiao Huang
- Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Mingli He
- Department of Neurology, First People's Hospital, Lianyungang
| | - Jia Fu
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei
| | - Yefeng Cai
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou
| | - Ping Li
- Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Xiaoshu Cheng
- Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Changyan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing
| | - Fang Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing
| | - Genfu Tang
- School of Health Administration, Anhui Medical University, Hefei
| | - Xianhui Qin
- National Clinical Research Study Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Binyan Wang
- National Clinical Research Study Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Hao Xue
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing
| | - Yundai Chen
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing
| | - Ye Tian
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin
| | - Ningling Sun
- Department of Cardiology, Peking University People's Hospital
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Fan Fan Hou
- National Clinical Research Study Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing
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Determinants of hyperhomocysteinemia in healthy and hypertensive subjects: A population-based study and systematic review. Clin Nutr 2016; 36:1215-1230. [PMID: 27908565 DOI: 10.1016/j.clnu.2016.11.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/16/2016] [Accepted: 11/11/2016] [Indexed: 01/18/2023]
Abstract
AIMS Hyperhomocysteinemia (HHcy) is known to increase the risk of many diseases. Factors influencing HHcy in healthy and hypertensive subjects remain under-researched. METHODS A large population-based study was conducted in 60 communities from Shenzhen, China. Responses to standardized questions on lifestyle factors and blood samples were collected from all participants after a 12-h overnight fast. Multiple linear and multivariate logistic regressions were used to explore risk factors for HHcy. Results were then compared to those from a systematic review of English-language articles listed in Pubmed, EBSCOhost, Web of Science, Embase and Cochrane libraries that investigated HHcy risk factors in healthy and hypertensive subjects. RESULTS A total of 1586 healthy (Male/Female = 642/944) and 5935 hypertensive subjects (Male/Female = 2928/3007) participated in our population-based study. In logistic regression analyses, age, BMI and creatinine (Cr) were risk factors, while being female, fruit intake and physical activity were protective factors for HHcy in healthy subjects. In hypertensive subjects, seven [age, smoking, salt intake, systolic blood pressure (SBP), uric acid, triglycerides (TG), and Cr] and four [female, fruit intake, total cholesterol (TC), and glucose] factors were associated with higher and lower HHcy respectively. The review of 71 studies revealed that potential risk factors for Hcy included nutritional, physiologic, lifestyle habits, ethnicity, genetics, interactions between gene-environment, gene-gene, gene-nutritional, environment-environment, nutritional-nutritional. CONCLUSION Our study indicates the potential importance of increasing folic acid and vitamin B supplementation, daily fruit and vegetable intake, regular exercise and refraining from tobacco smoking and alcohol consumption as preventive strategies for Hcy.
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Bedreag OH, Rogobete AF, Sandesc D, Cradigati CA, Sarandan M, Nartita R, Dumache R, Diaconu MM, Papurica M. The Effects of Homocysteine Level in the Critically Ill Patient. A Review. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
Increased levels of homocysteine (HCYS) represent a risk factor for a series of physiopathological conditions: mental retardation, cardiovascular and neurodegenerative diseases, Parkinson's and Alzheimer's disease, depression, osteoporosis, endothelial dysfunction and inhibition of cell proliferation. This paper aims to present the pathophysiological implications of HCYS and the correlation of hyperhomocysteinemia (H-HCYS) with critical condition in the intensive care unit (ICU). Hypovitaminosis B and folate deficiency is directly involved in the inhibition of HCYS metabolism and the accumulation of HCYS in the plasma and tissues. Critically ill patients are more prone to H-HCYS due to hypermetabolism and accelerated synthesis produced by reactive oxygen species (ROS). In conclusion it can be affirmed that the determination and monitoring of HCYS plasma levels may be of interest in optimizing the therapy for critically ill patients. Moreover, by controlling HCYS levels, and implicitly the essential cofactors that intervene in the specific biochemical pathways, such as vitamin B6, vitamin B12 and folic acid can provide a diversified and personalized treatment for each patient.
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Affiliation(s)
- Ovidiu Horea Bedreag
- Clinic of Anesthesia and Intensive Care, “Pius Brinzeu” County Emergency Hospital, Timișoara, Romania
- Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
| | - Alexandru Florin Rogobete
- Clinic of Anesthesia and Intensive Care, “Pius Brinzeu” County Emergency Hospital, Timișoara, Romania
- Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
| | - Dorel Sandesc
- Clinic of Anesthesia and Intensive Care, “Pius Brinzeu” County Emergency Hospital, Timișoara, Romania
- Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
| | - Carmen Alina Cradigati
- “Casa Austria” Clinic of Anesthesia and Intensive Care, “Pius Brinzeu” County Emergency Hospital, Timișoara, Romania
| | - Mirela Sarandan
- “Casa Austria” Clinic of Anesthesia and Intensive Care, “Pius Brinzeu” County Emergency Hospital, Timișoara, Romania
| | - Radu Nartita
- Faculty of Chemistry, Biology and Geography, West University of Timișoara, Romania
| | - Raluca Dumache
- Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
| | - Mihai Mircea Diaconu
- Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
| | - Marius Papurica
- Clinic of Anesthesia and Intensive Care, “Pius Brinzeu” County Emergency Hospital, Timișoara, Romania
- Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
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High Prevalence of Hyperhomocysteinemia and Its Association with Target Organ Damage in Chinese Patients with Chronic Kidney Disease. Nutrients 2016; 8:nu8100645. [PMID: 27775590 PMCID: PMC5084032 DOI: 10.3390/nu8100645] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 02/07/2023] Open
Abstract
Hyperhomocysteinemia (HHcy) is recognized as a risk factor for cardiovascular disease. However, the prevalence of HHcy and its role in association with target organ damage in patients with chronickidney disease (CKD) are not well understood. This cross-sectional study included 1042 CKD patients who were admitted to our hospital. Patients were divided into two groups: hyperhomocysteinemia and normohomocysteinemia. Multivariable linear regression analyses were used to evaluate the association between plasma homocysteine and renal/cardiovascular parameters. The prevalence of HHcy in patients with CKD was 52.78%, and the prevalence in CKD stage 1, stage 2, stage 3, stage 4 and stage 5 patients was 10.73%, 29.22%, 58.71%, 75.23% and 83.75%, respectively. Patients with HHcy had higher incidences of renal damage, left ventricular hypertrophy, left ventricular diastolic dysfunction and abnormal carotid intima-media thickness compared with patients with normohomocysteinemia (p < 0.05), while multivariable linear regression analyses showed plasma homocysteine was only associated with the estimated glomerular filtration rate (eGFR). eGFR, uric acid, albumin, gender, hemoglobin and calcium×phosphate were associated with levels of plasma homocysteine in these CKD patients. The prevalence of HHcy in Chinese patients with CKD was high, and serum homocysteine levels were associated with impaired renal function in these patients.
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Pang H, Han B, Fu Q, Zong Z. Association of High Homocysteine Levels With the Risk Stratification in Hypertensive Patients at Risk of Stroke. Clin Ther 2016; 38:1184-92. [PMID: 27021605 DOI: 10.1016/j.clinthera.2016.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/27/2016] [Accepted: 03/01/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE We aimed to investigate the association between stroke morbidity and different stratifications of classic risk factors, such as increasing age, body mass index (BMI), blood lipids, and blood glucose, in hypertensive patients with high homocysteine levels. METHODS A cross-sectional study of 2258 patients with primary hypertension were enrolled in this study, including 871 stroke cases (62.89%) in 1385 hypertensive patients without hyperhomocysteinemia (HHcy) and 647 (74.11%) stroke cases in 873 hypertensive patients with HHcy. Basic information of patients were collected, including age, sex, height, weight, smoking, alcohol consumption, and disease history. Blood chemical assays were performed to determine the levels of glucose, triglycerides, high-density lipoprotein cholesterol (HDL-C), total cholesterol, and homocysteine. Subsequently, comparison of stroke morbidity between the 2 groups was performed after the stratification of risk factors. Moreover, the correlation between the stroke morbidity and the risk factors was analyzed using a trend test in patients with H-type hypertension. Univariate and multivariate logistic regression analyses were used to evaluate the association between baseline factors and prevalence of stroke in H-type hypertensive patients. FINDINGS After the stratification of risk factors, a statistical difference was noted in age (range, 45-74 yrs), glucose ranges (<6.1 and ≥7.0 mmol/L), BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), non-HDL-C, and triglyceride level of <200 mg/dL (P<0.05) in the H-type hypertension group compared with those in non-H-type hypertension group. Gradual elevation of stroke morbidity was identified with the increase of fasting glucose, SBP, and DBP. In multivariate logistic regression analysis, only higher SBP, DBP, fasting glucose level, homocysteine, and history of diabetes mellitus were the independent predictors for the stroke morbidity. IMPLICATIONS Comprehensive evaluation and strict management of multiple risk factors have become increasingly important in the alleviation of stroke morbidity for H-type hypertensive patients because these patients were more sensitive to the classic risk factors.
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Affiliation(s)
- Hui Pang
- Department of Cardiovascular Medicine, XuZhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College, Affiliated XuZhou Hospital of Medical College of Southeast University, Xuzhou, Jiangsu, China.
| | - Bing Han
- Department of Cardiovascular Medicine, XuZhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College, Affiliated XuZhou Hospital of Medical College of Southeast University, Xuzhou, Jiangsu, China
| | - Qiang Fu
- Department of Cardiovascular Medicine, XuZhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College, Affiliated XuZhou Hospital of Medical College of Southeast University, Xuzhou, Jiangsu, China
| | - Zhenkun Zong
- Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, China
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Zhong C, Xu T, Xu T, Peng Y, Wang A, Wang J, Peng H, Li Q, Geng D, Zhang D, Zhang Y, Zhang Y, Gao X, He J. Plasma Homocysteine and Prognosis of Acute Ischemic Stroke: a Gender-Specific Analysis From CATIS Randomized Clinical Trial. Mol Neurobiol 2016; 54:2022-2030. [PMID: 26910818 DOI: 10.1007/s12035-016-9799-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 02/16/2016] [Indexed: 11/24/2022]
Abstract
Elevated total homocysteine level (tHcy) has been hypothesized to be associated with morbidity and mortality of stroke; however, results regarding the association between plasma tHcy status and prognosis of acute ischemic stroke are inconsistent. Moreover, the gender effect on this association has yet to be explored. We thus prospectively investigated whether higher tHcy concentrations predicted poor stroke prognosis in Chinese adults. A total of 3309 acute ischemic stroke patients were included in this prospective multicenter study from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). Baseline tHcy concentrations were quantitatively determined via enzymatic cycling assay. The primary outcome was a combination of death and major disability at 3 months (modified Rankin scale scores 3-6) after hospitalization. Multivariate logistic regression models with restricted cubic splines were used to determine the association between baseline plasma tHcy and the subsequent outcome. Higher plasma tHcy concentrations were associated with increased risks of the primary outcome in women but not in men (P interaction = 0.016). Adjusted odds ratios comparing two extreme tHcy quartiles were 1.83 (95 % confidence interval 1.12-2.98; P trend = 0.02) in women and 0.87 (95 % confidence interval 0.61-1.25; P trend = 0.37) in men. The significant association between baseline tHcy status and stroke prognosis in women, but not in men, persisted in further subgroup analyses, stratified by age, baseline systolic blood pressure, and other pre-specified factors. Elevated tHcy is positively associated with poor prognosis of acute ischemic stroke in women, but not in men. Further studies are needed to replicate our findings and to clarify the potential sex-specific mechanisms.
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Affiliation(s)
- Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China.,Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Tian Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China.,Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yanbo Peng
- Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Hebei, China
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China
| | - Jinchao Wang
- Department of Neurology, Yutian County Hospital, Hebei, China
| | - Hao Peng
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China
| | - Qunwei Li
- Department of Epidemiology, School of Public Health, Taishan Medical College, Shandong, China
| | - Deqin Geng
- Department of Neurology, Affiliated Hospital of Xuzhou Medical College, Jiangsu, China
| | - Dongsheng Zhang
- Department of Neurology and Cardiology, Dongping County People's Hospital, Dongping, Shandong, China
| | - Yuming Zhang
- Department of Neurology, Wenshang County Hospital of Traditional Chinese Medicine, Shandong, China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China. .,Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Xiang Gao
- Department of Nutritional Science, The Pennsylvania State University, University Park, PA, USA.
| | - Jiang He
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China. .,Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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Ren MY, Zhang CS, Zhang XJ, Zhong JQ. Acute Myocardial Infarction in a Young Man with Hyperhomocysteinemia and Pulmonary Tuberculosis. Intern Med 2016; 55:153-9. [PMID: 26781015 DOI: 10.2169/internalmedicine.55.4565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Acute myocardial infarction, hyperhomocysteinemia and pulmonary tuberculosis (PTB) are rare in individuals under the age of 30 years. We herein report the case of a 27-year-old man who presented with intermittent chest pain, elevated homosysteine level, and PTB. The patient was treated successfully with a combination of medications and percutaneous coronary intervention. This uncommon case highlights that homocysteine, folate and B vitamins levels should be regularly evaluated, and that chest X-rays or thoracic computed tomography should be ordered routinely to exclude PTB in patients under the age of 30 years who present acute myocardial infarction and lack the traditional risk factors.
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Affiliation(s)
- Man-Yi Ren
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Qilu Hospital of Shandong University, China
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Serum Homocysteine Concentration Is Significantly Associated with Inflammatory/Immune Factors. PLoS One 2015; 10:e0138099. [PMID: 26367537 PMCID: PMC4569057 DOI: 10.1371/journal.pone.0138099] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 08/25/2015] [Indexed: 11/23/2022] Open
Abstract
Recent studies suggest that serum homocysteine (HCY) level is correlated to inflammatory/immune factors that influence the development and progression of many diseases, such as cardiovascular disease. However, the association between serum HCY level and inflammatory/immune factors in healthy populations has not been systematically investigated. This study was conducted based on the Fangchenggang Area Male Health and Examination Survey (FAMHES) project. After comprehensive baseline analysis, we could not find any significant association between HCY level and inflammatory/immune factors. However, in the next linear regression analysis, serum C4 [age-adjusted: Beta = -0.053, 95%CI = (-3.798, -0.050), P = 0.044; multivariate adjusted: Beta = -0.064, 95%CI = (-4.271, -0.378), P = 0.019] and C-reactive protein (CRP) concentration [unadjusted: Beta = 0.056, 95%CI = (0.037, 0.740), P = 0.030] were positively related with HCY. In further binary regression analysis, a significant correlation was confirmed for C4 and HCY [age-adjusted: OR = 0.572, 95%CI = (0.359, 0.911); multivariate adjusted: OR = 0.558, 95%CI = (0.344, 0.905)]. In order to discover more potential associations, multivariate logistic regression analysis was applied and suggested that HCY and C4 were significantly correlated [age-adjusted: OR = 0.703, 95%CI = (0.519, 0.951); multivariate adjusted: OR = 0.696, 95%CI = (0.509, 0.951)]. In addition, immunoglobulin M (IgM) may influence the HCY level to some extent [unadjusted: OR = 1.427, 95%CI = (1.052, 1.936); age-adjusted: OR = 1.446, 95%CI = (1.061, 1.970); multivariate adjusted: OR = 1.447, 95%CI = (1.062, 1.973)]. Combining our results with recent studies, we propose that C4, CRP, and IgM in serum are significantly associated with HCY concentration. Further studies are needed on the mechanism of the interaction, especially among cardiovascular disease subjects.
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Homocysteine, Ischemic Stroke, and Coronary Heart Disease in Hypertensive Patients. Stroke 2015; 46:1777-86. [DOI: 10.1161/strokeaha.115.009111] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/05/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Total homocysteine level (tHcy) is a risk factor of ischemic stroke (IS) and coronary heart disease. However, the results are conflicting and mainly focused on healthy individuals in developed countries.
Methods—
A prospective, population-based cohort study was conducted among 5935 participants from 60 communities in the city of Shenzhen, China. A Cox regression analysis was applied to evaluate the contribution of tHcy to the risk of IS and coronary heart disease. The effect of folic acid supplementation on tHcy levels was also evaluated among 501 patients with essential hypertension, who received an average of 2.5 years of folic acid supplementation.
Results—
After adjustment for confounding factors, the hazard ratios (95% confidence intervals) of IS caused by hyperhomocysteinemia were 2.18 (1.65–2.89), 2.40 (1.56–3.67), and 2.73 (1.83–4.08) in the total, male, and female participants, respectively. Compared with normal levels of tHcy (<15 μmol/L), the hazard ratios (95% confidence intervals) for IS in the highest tHcy category (≥30 μmol/L) were 4.96 (3.03–8.12), 6.11 (3.44–10.85), and 1.84 (0.52–6.46) in the total, males, and females participants, respectively. However, we did not observe a significant relationship between tHcy and the risk of coronary heart disease. The 2.5 years of folic acid supplementation reduced tHcy levels by 6.7 μmol/L (27.92%) in patients with essential hypertension.
Conclusions—
Hyperhomocysteinemia in Chinese hypertensive patients is significantly associated with IS risk but not coronary heart disease susceptibility, and folic acid supplementation can efficiently reduce tHcy levels.
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Guo S, Pang H, Guo H, Zhang M, He J, Yan Y, Niu Q, Rui D, Li S, Ma R, Zhang J, Liu J, Ding Y. Ethnic differences in the prevalence of high homocysteine levels among low-income rural Kazakh and Uyghur adults in far western China and its implications for preventive public health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5373-85. [PMID: 25996889 PMCID: PMC4454973 DOI: 10.3390/ijerph120505373] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/02/2015] [Accepted: 05/11/2015] [Indexed: 12/14/2022]
Abstract
Objective: Homocysteine (Hcy) is a relevant biomarker of vascular disease: serum Hcy concentrations will increase the risk of systolic hypertension, whereas hyperhomocysteinemia (HHcy) has a synergistic effect with hypertension and increases the risk of cardiovascular disease. However, information has primarily been gathered from high-income and urban settings, and little is known regarding low-income rural settings. This study focused on a low-income rural and nomadic minority residing in far western China. Hcy levels were tested, and the prevalences of HHcy and H-type hypertension were investigated in this population. Methods: This study used a stratified cluster random sampling method, selecting 2,180 individuals as subjects from Kazakh and Uyghur inhabitants (≥25 years old) of 18 villages in Xinjiang, China, which is approximately 4407 km from the capital, Beijing. Hcy levels were determined using a double reagent enzymatic cycling method. HHcy (Hcy > 10 μmol/L) was defined by the criteria of the American Heart Association. Results: The Kazakh geometrical mean of Hcy was 13.34 μmol/L, and the Uyghur mean was 13.75 μmol/L; the mean values were higher in males than in females of both ethnicities (15.99 μmol/L vs. 11.63 μmol/L; 15.71 μmol/L vs. 11.91 μmol/L, respectively, p < 0.01). The serum levels of Hcy increased with increasing age in both ethnicities, and except for Kazakh individuals >65 years old, Hcy serum levels were higher in males than in females in all age groups of both ethnicities, with a p value less than 0.01. The Kazakh prevalence of HHcy was 80.0%, and the Uyghur prevalence was 78.2%; the male prevalence was higher than that in females for both ethnicities (93.5% vs. 69.6%; 90.8% vs. 64.6%, respectively, p < 0.05). Among the Kazakh, the prevalence of hypertension was 35.1%, and the prevalence was higher in males than in females (44.3% vs. 28.1%, p < 0.001); 87.6% of the Kazakh individuals had H-type hypertension, and the prevalence was higher in males than in females (95.0% vs. 80.0%, p < 0.05). In Uyghur, the prevalence of hypertension was 30.6%, and the prevalence was higher in males than in females (37.9% vs. 22.8%, p < 0.001); 88.0% of the Uyghur individuals had H-type hypertension, and the prevalence was higher in males than in females (93.9% vs. 79.1%, p < 0.05). Conclusions: HHcy was found to be common among the Kazakh and Uyghur. The prevalences of HHcy and H-type hypertension were high among both ethnicities and differed depending on gender and age. Community interventions should be conducted to improve public health conditions among the Kazakh and Uyghur in Xinjiang.
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Affiliation(s)
- Shuxia Guo
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, School of Medicine, Shihezi University, Beier Road, Shihezi City, Xinjiang Uyghur Autonomous Region 832000, China.
| | - Hongrui Pang
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, School of Medicine, Shihezi University, Beier Road, Shihezi City, Xinjiang Uyghur Autonomous Region 832000, China.
| | - Heng Guo
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, School of Medicine, Shihezi University, Beier Road, Shihezi City, Xinjiang Uyghur Autonomous Region 832000, China.
| | - Mei Zhang
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, School of Medicine, Shihezi University, Beier Road, Shihezi City, Xinjiang Uyghur Autonomous Region 832000, China.
| | - Jia He
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, School of Medicine, Shihezi University, Beier Road, Shihezi City, Xinjiang Uyghur Autonomous Region 832000, China.
| | - Yizhong Yan
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, School of Medicine, Shihezi University, Beier Road, Shihezi City, Xinjiang Uyghur Autonomous Region 832000, China.
| | - Qiang Niu
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, School of Medicine, Shihezi University, Beier Road, Shihezi City, Xinjiang Uyghur Autonomous Region 832000, China.
| | - Dongsheng Rui
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, School of Medicine, Shihezi University, Beier Road, Shihezi City, Xinjiang Uyghur Autonomous Region 832000, China.
| | - Shugang Li
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, School of Medicine, Shihezi University, Beier Road, Shihezi City, Xinjiang Uyghur Autonomous Region 832000, China.
| | - Rulin Ma
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, School of Medicine, Shihezi University, Beier Road, Shihezi City, Xinjiang Uyghur Autonomous Region 832000, China.
| | - Jingyu Zhang
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, School of Medicine, Shihezi University, Beier Road, Shihezi City, Xinjiang Uyghur Autonomous Region 832000, China.
| | - Jiaming Liu
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, School of Medicine, Shihezi University, Beier Road, Shihezi City, Xinjiang Uyghur Autonomous Region 832000, China.
| | - Yusong Ding
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, School of Medicine, Shihezi University, Beier Road, Shihezi City, Xinjiang Uyghur Autonomous Region 832000, China.
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Cao C, Hu J, Dong Y, Zhan R, Li P, Su H, Peng Q, Wu T, Lei L, Huang X, Wu Q, Cheng X. Gender differences in the risk factors for endothelial dysfunction in Chinese hypertensive patients: homocysteine is an independent risk factor in females. PLoS One 2015; 10:e0118686. [PMID: 25692574 PMCID: PMC4334966 DOI: 10.1371/journal.pone.0118686] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 01/08/2015] [Indexed: 12/31/2022] Open
Abstract
Objectives Endothelial dysfunction plays a key role in the pathogenesis of cardiovascular disease. However, the gender-related differences in risk factors for endothelial dysfunction are controversial. We investigated the gender differences in the risk factor profiles for endothelial dysfunction in Chinese hypertensive patients. Methods Vascular endothelial functions in 213 hypertensive patients were measured by digital reactive hyperemia peripheral arterial tonometry (RH-PAT). Peripheral blood samples were collected, and the self-reported smoking and alcohol consumption status, age, body mass index, heart rate, blood pressure and drug administrations were recorded. Results RH-PAT indexes were attenuated in both male and female hypertensive patients [1.60 (1.38-2.02) vs. 1.63 (1.44-1.98)]. Multivariate logistic regression analysis identified plasma creatinine (p < 0.001), total cholesterol (p = 0.001), homocysteine (p = 0.002) and smoking (p < 0.001) as the independent factors correlated with gender (male). Multivariate linear regression analysis further identified homocysteine as the factor that is significantly and independently correlated with the decrease in the RH-PAT indexes in female patients (odds ratio: -0.166, 95% confidence interval: -0.292 to -0.040, p = 0.01). However, none of these four factors were correlated with the RH-PAT indexes in male patients. Conclusions There are gender-related differences in the risk factors for endothelial dysfunction in Chinese hypertensive patients. Homocysteine is an independent factor for endothelial dysfunction in female hypertensive patients.
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Affiliation(s)
- Cheng Cao
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Jianxin Hu
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Yifei Dong
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
- Key Laboratory of Molecular Biology in Jiangxi Province, Nanchang City, Jiangxi Province, China
- * E-mail:
| | - Rui Zhan
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Ping Li
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Hai Su
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Qiang Peng
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Tao Wu
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Liang Lei
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Qinghua Wu
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
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Wang Y, Chen S, Yao T, Li D, Wang Y, Li Y, Wu S, Cai J. Homocysteine as a risk factor for hypertension: a 2-year follow-up study. PLoS One 2014; 9:e108223. [PMID: 25310282 PMCID: PMC4195588 DOI: 10.1371/journal.pone.0108223] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 08/27/2014] [Indexed: 11/24/2022] Open
Abstract
Homocysteine (Hcy) is regarded as a risk factor for hypertension, but research on the causal relationship between Hcy and hypertension is limited. In the present study, we prospectively tracked the blood pressure progression of a normotensive population with different Hcy levels over a 2-year period. The incidence of hypertension with increasing Hcy quartiles produced an approximately U-shaped curve, with significance in males. Compared with the third quartile, the risk of hypertension in the first and second quartiles was increased by 1.55 (95% confidence interval [CI] 1.154–2.081) fold and 1.501 (95% CI 1.119–2.013) fold, respectively, with the increase being more significant in males. In conclusion, Hcy is related to hypertension incidence with the results approximating an U-shaped curve. Low Hcy levels might also increase the risk of hypertension.
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Affiliation(s)
- Yixuan Wang
- Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Shuohua Chen
- Health Department of Kailuan Group, Tangshan, China
| | - Tao Yao
- Linxi Hospital, Affiliated Kailuan General Hospital, Hebei United University, Tangshan, China
| | - DongQing Li
- Department of Cardiology, The Kailuan General Hospital, Hebei United University, Tangshan, China
| | - YanXiu Wang
- Department of Cardiology, The Kailuan General Hospital, Hebei United University, Tangshan, China
| | - YuQing Li
- Department of Rheumatology and Immunology, The Kailuan General Hospital, Hebei United University, Tangshan, China
| | - ShouLing Wu
- Department of Cardiology, The Kailuan General Hospital, Hebei United University, Tangshan, China
- * E-mail: (SW); (JC)
| | - Jun Cai
- Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
- * E-mail: (SW); (JC)
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