[Determinants and relationship of homocysteinemia with cardiometabolic risk factors. A study in Benin, West Africa]

Prevalence of hyperhomocysteinaemia, selected determinants and relation to hypertension severity in Northern-Nigerian hypertensives: the ABU homocysteine survey

Background

This study aimed at evaluating the prevalence of hyperhomocysteinaemia in Northern-Nigerian hypertensives and its association with hypertension severity and some major determinants as data regarding these are lacking in sub-Saharan Africa.

Method

A Community-based cross-sectional study done on 120 randomly-selected hypertensive patients who responded to an ABU radio frequency modulated invitation for free health-screening at the Ahmadu Bello University (ABU) Medical Centre from January 2016 to June 2016. The percentage of participants with high homocysteine levels, their anthropometric parameters and blood pressures were determined. Plasma homocysteine (hcy) was classified as normal (5–15), moderate (>15–30), intermediate (31–100) and severe (>100) µmol/L. Kruskal-Wallis test was applied and log-transformed homocysteine (Ln₁₀Homocysteine) was correlated with systolic and diastolic blood pressures as well as age, body mass index, fasting blood glucose, glomerular filtration rate, hypertension duration and Ln₁₀folate in males and females using the Pearson's Correlation analysis.

Results

There were 83(69.2%) females and 37(30.8%) males with Median homocysteine of 20.8 µmol/L and 22.0 µmol/L respectively (p=0.003). Hyperhomocysteinaemia was found in 118(98.3%) hypertensives while 2(1.7%) subjects had normo-homocysteinaemia. Moderate hyperhomocysteinaemia (Median, 20.8 µmol/L) was identified in 105(87.5%) and intermediate (Median, 40 µmol/L) in 13(10.8%) (p<0.001). No subject had severe hyperhomocysteinaemia. Homocysteine was higher (p=0.003) in subjects with Stage 2 systolic hypertension. Ln₁₀Homocysteine was significantly (p<0.001) correlated with blood pressure (SBP: r=0.45; DBP: r=0.40) and age (r=0.33).

Conclusion

The prevalence of hyperhomocysteinaemia in North-Western Nigerian hypertensives is high as against normal healthy controls. Plasma homocysteine is higher with severe systolic hypertension and positively associated with age.

Funding

No specific grants but Micro Nova Pharmaceuticals Limited, Nigeria and Emzor Pharmaceutical Industries, Lagos, Nigeria supported with drugs.

Relationship between plasma homocysteine and blood pressure in hypertensive Northern-Nigerians

AIM

The study sought to determine whether there is any relationship between plasma homocysteine and blood pressure levels in Nigerians with essential hypertension.

METHOD

It was a cross-sectional analytical study done on 120 randomly selected hypertensive patients and 120 normal healthy controls seen at the large Conference hall of the Ahmadu Bello University (ABU) Medical Centre, Zaria as well as the ABU Teaching Hospital, Zaria, Northern-Nigeria. Pearson's Correlation and Binary Logistic Regression analysis determined the relationship between homocysteine and hypertension.

RESULTS

Hyperhomocysteinaemia found in the hypertensive patients (22.8 ± 6.6 µmol/L) differed significantly (p<0.001) from controls (10.9 ± 2.8 µmol/L) with significant (p<0.001), blood pressure difference between both groups. Homocysteine significantly positively correlated with systolic (r = 0.51, p<0.001) and diastolic (r = 0.47, p<0.001) blood pressures in hypertensive subjects. The relation of plasma hcy to hypertension was statistically significant for SBP; OR: 1.08 (95% CI, 1.05-1.11) and DBP; OR: 1.08 (95% CI, 1.03-1.13) in the unadjusted model. When adjusted for confounding variables, hcy was significantly related to SBP; OR: 1.1 (95% CI, 1.04-1.18) but not DBP (p=0.25; OR: 1.06 (95 % CI, 0.96-1.18). The mean plasma folate level was high (115.2 ± 48.0 ng/mL) in the hypertensive subjects. The hyperhomocysteinaemic subjects showed a 2.8 times Odds of developing hypertension.

CONCLUSION

This study showed higher mean plasma homocysteine levels in hypertensives than controls not accounted for by sub-optimal folate levels. Hyperhomocysteinaemia showed a positive relationship to systolic hypertension after adjusting for confounders.

Hyperhomocysteinemia independently associated with the risk of hypertension: a cross-sectional study from rural China

This study was designed to investigate the current prevalence of hyperhomocysteinemia (Hhcy) and its association with hypertension in rural adults of Northeast China. A cross-sectional study was performed in subjects aged⩾35 years in a general Chinese population. Demographic data, laboratory examination of traditional cardiovascular risk factors and self-reported information on lifestyle factors, such as physical activities, current smoking and drinking status, dietary habits and familial factors were collected by trained personnel. A total of 7130 participants (3317 men and 3813 women) were included in this study and the mean Hhcy level of the whole population was 17.39±12.34 mmol l(-1), which was 20.99±14.83 mmol l(-1) in males and 14.19±8.51 mmol l(-1) in females, respectively. Prevalence of Hhcy in total population was 41.3%. Stratified by gender, the prevalence of Hhcy was higher in males than in females (59.0 vs 25.8%, P<0.05). After adjustment for conventional risk factors including age, salt intake, smoking, body mass index, diabetes, dyslipidemia, activity time and family history, multiple logistic regression analysis showed that Hhcy was independently associated with the risk of hypertension in males (odds ratio (OR)=1.501, 95% confidence interval (CI): 1.012-2.227; P<0.001), but not in females in this population (OR=1.182; 95% CI, 0.993-1.407; P=0.060). In conclusion, a high prevalence of Hhcy in the general adult population of rural northeast China was detected and Hhcy may be a risk factor for hypertension, particularly in males.

At-risk serum cholesterol profile at both ends of the nutrition spectrum in West African adults? The Benin study

Low HDL-cholesterol (HDL-C), using as cut-offs 1.03 mmol/L in men and 1.29 mmol/L in women, was observed in more than 25% apparently healthy adults (n = 541) in a cross-sectional study on nutrition transition and cardiometabolic risk factors (CMRF) in Benin, West Africa. Both overweight/obesity (35.3%) and underweight (11.3%) were present, displaying the double burden of malnutrition. We examined in more depth the association of low HDL-C with nutrition and with other CMRF. Metabolic syndrome components were assessed, plus the ratio of total cholesterol (TC)/HDL-C and serum homocysteine. Insulin resistance was based on Homeostasis Model Assessment. We also measured BMI and body composition by bio-impedance. Dietary quality was appraised with two non-consecutive 24 h recalls. Low HDL-C was associated with much higher TC/HDL-C and more abdominal obesity in men and women and with more insulin resistance in women. The rate of low HDL-C was highest (41.9%) among the overweight/obese subjects (BMI ≥ 25), but it also reached 31.1% among the underweight (BMI < 18.5), compared with 17.3% among normal-weight subjects (p < 0.001). Lower dietary micronutrient adequacy, in particular, in vitamins A, B₃, B_12, zinc and calcium, was associated with low HDL-C when controlling for several confounders. This suggests that at-risk lipoprotein cholesterol may be associated with either underweight or overweight/obesity and with poor micronutrient intake.