1
|
Wang L, Chen J, Li J, Hu F, Xie Y, Zhou X, Shen S, Zhou W, Zhu L, Wang T, Tu J, Bao H, Cheng X. Threshold effect of plasma total homocysteine levels on cognitive function among hypertensive patients in China: A cross-sectional study. Front Neurol 2022; 13:890499. [PMID: 36061998 PMCID: PMC9434013 DOI: 10.3389/fneur.2022.890499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Increased plasma total homocysteine (tHcy) is an influencing factor of cognitive impairment in the general population. However, studies on the relationship between the risk of cognitive impairment and plasma tHcy levels in patients with hypertension are limited. This study aimed to explore the association between plasma tHcy levels and cognitive function assessed by MMSE scores among hypertensive patients in China. Methods A total of 9,527 subjects from the Chinese Hypertension Registry Study participated in this study. Plasma tHcy levels were quantified by high-performance liquid chromatography using a fluorescence detector. Cognitive assessment was performed using the Mini-Mental State Examination (MMSE). Linear regression models, two piecewise linear regression models, and smoothing curve fitting were applied to determine the relationship between plasma tHcy levels and cognitive function. Results This analysis included 9,527 Chinese hypertensive adults. Based on the results of linear regression models, a negative relationship was identified between plasma tHcy levels and MMSE scores [beta coefficient (β) per standard deviation (SD) increase: −0.26, 95% confidence interval (CI) −0.35, −0.16, P < 0.001]. The fully adjusted smooth curve fitting presented a nonlinear between plasma tHcy levels and MMSE scores. The threshold effect analysis showed that the inflection point of tHcy was about 27.1 μmol/L. The effect size [β (95% CI)] per SD increase in plasma tHcy concentrations on MMSE scores was −0.93 (−1.24, −0.6) on the left side and −0.07 (−0.24, 0.10) on the right side of the inflection point (P-value for log-likelihood ratio (LLR) test was <0.001). Moreover, subgroup analyses revealed that sex could influence the negative association between plasma tHcy levels and MMSE scores up to a specific threshold (P-value for interaction <0.001). Linear regression models indicated that there was an enhanced inverse association between tHcy levels and MMSE scores in female patients with tHcy concentrations less than 26.9 μmol/L compared to male patients with tHcy concentrations less than 32.0 μmol/L. Conclusions Plasma tHcy levels had a threshold effect on MMSE scores among hypertensive patients in China. Increased plasma tHcy levels were independently inversely associated with cognitive decline among hypertensive patients with tHcy concentrations <27.1 μmol/L.
Collapse
Affiliation(s)
- Li Wang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
| | | | - Junpei Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
| | - Feng Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
| | - Yanyou Xie
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
| | - Xinlei Zhou
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
| | - Si Shen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
| | - Wei Zhou
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lingjuan Zhu
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Wang
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianglong Tu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huihui Bao
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Huihui Bao
| | - Xiaoshu Cheng
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Xiaoshu Cheng
| |
Collapse
|
3
|
Li J, Wang Y, Li H, Zuo Z, Lin J, Wang A, Zhao X, Liu L, Wang Y. Homocysteine Level Predicts Response to Dual Antiplatelet in Women With Minor Stroke or Transient Ischemic Attack: Subanalysis of the CHANCE Trial. Arterioscler Thromb Vasc Biol 2020; 40:839-846. [PMID: 31941381 DOI: 10.1161/atvbaha.119.313741] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the relationship of homocysteine levels with the efficacy and safety of dual antiplatelet therapy in female and male patients. Approach and Results: The CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) randomized patients with acute minor ischemic stroke or high-risk transient ischemic attack to clopidogrel plus aspirin or aspirin alone from October 1, 2009, to July 30, 2012, in China. A subgroup of 3044 consecutive patients with baseline homocysteine levels from 73 (64%) prespecified clinical sites was analyzed. Participants were grouped by sex. Primary outcome was stroke recurrence within 90 days. Secondary outcomes consisted of composite vascular events and independent living or death. Safety outcome was any bleeding. Cox proportional-hazards models were used to assess the interaction of homocysteine levels with randomized antiplatelet therapy on efficacy and safety outcomes. A significant interaction between homocysteine levels and the randomized antiplatelet therapies was found on recurrent stroke after adjustment for confounding factors in women (P=0.010) but not in men (P=0.595). Compared with aspirin alone, clopidogrel plus aspirin significantly reduced the risk of recurrent stroke in women without elevated homocysteine levels (adjusted hazard ratio, 0.459 [95% CI, 0.271-0.776]; P=0.004). Such benefit disappeared in female patients with increased homocysteine level. No significant interaction on functional outcome or bleeding rate was observed. CONCLUSIONS Homocysteine could be a potential biomarker to discriminate the effects of dual and single antiplatelet therapy in female patients with minor ischemic stroke or high-risk transient ischemic attack. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979589.
Collapse
Affiliation(s)
- Jiejie Li
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang)
| | - Yilong Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang)
| | - Hao Li
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang)
| | - Zhiyi Zuo
- Department of Anesthesiology, University of Virginia Health System, Charlottesville (Z.Z.)
| | - Jinxi Lin
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang)
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang)
| | - Xingquan Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang)
| | - Liping Liu
- China National Clinical Research Center for Neurological Diseases, Beijing, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang)
| | - Yongjun Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J. Li, Yilong Wang., H.L., J. Lin, A.W., X.Z., L.L., Yongjun Wang)
| | | |
Collapse
|
5
|
Albert CM, Cook NR, Gaziano JM, Zaharris E, MacFadyen J, Danielson E, Buring JE, Manson JE. Effect of folic acid and B vitamins on risk of cardiovascular events and total mortality among women at high risk for cardiovascular disease: a randomized trial. JAMA 2008; 299:2027-36. [PMID: 18460663 PMCID: PMC2684623 DOI: 10.1001/jama.299.17.2027] [Citation(s) in RCA: 343] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Recent randomized trials among patients with preexisting cardiovascular disease (CVD) have failed to support benefits of B-vitamin supplementation on cardiovascular risk. Observational data suggest benefits may be greater among women, yet women have been underrepresented in published randomized trials. OBJECTIVE To test whether a combination of folic acid, vitamin B6, and vitamin B12 lowers risk of CVD among high-risk women with and without CVD. DESIGN, SETTING, AND PARTICIPANTS Within an ongoing randomized trial of antioxidant vitamins, 5442 women who were US health professionals aged 42 years or older, with either a history of CVD or 3 or more coronary risk factors, were enrolled in a randomized, double-blind, placebo-controlled trial to receive a combination pill containing folic acid, vitamin B6, and vitamin B12 or a matching placebo, and were treated for 7.3 years from April 1998 through July 2005. INTERVENTION Daily intake of a combination pill of 2.5 mg of folic acid, 50 mg of vitamin B6, and 1 mg of vitamin B12. MAIN OUTCOME MEASURES A composite outcome of myocardial infarction, stroke, coronary revascularization, or CVD mortality. RESULTS Compared with placebo, a total of 796 women experienced a confirmed CVD event (406 in the active group and 390 in the placebo group). Patients receiving active vitamin treatment had similar risk for the composite CVD primary end point (226.9/10,000 person-years vs 219.2/10,000 person-years for the active vs placebo group; relative risk [RR], 1.03; 95% confidence interval [CI], 0.90-1.19; P = .65), as well as for the secondary outcomes including myocardial infarction (34.5/10,000 person-years vs 39.5/10,000 person-years; RR, 0.87; 95% CI, 0.63-1.22; P = .42), stroke (41.9/10,000 person-years vs 36.8/10,000 person-years; RR, 1.14; 95% CI, 0.82-1.57; P = .44), and CVD mortality (50.3/10,000 person-years vs 49.6/10,000 person-years; RR, 1.01; 95% CI, 0.76-1.35; P = .93). In a blood substudy, geometric mean plasma homocysteine level was decreased by 18.5% (95% CI, 12.5%-24.1%; P < .001) in the active group (n = 150) over that observed in the placebo group (n = 150), for a difference of 2.27 micromol/L (95% CI, 1.54-2.96 micromol/L). CONCLUSION After 7.3 years of treatment and follow-up, a combination pill of folic acid, vitamin B6, and vitamin B12 did not reduce a combined end point of total cardiovascular events among high-risk women, despite significant homocysteine lowering. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00000541.
Collapse
Affiliation(s)
- Christine M Albert
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Ave E, Boston, Massachusetts 02215-1204, USA.
| | | | | | | | | | | | | | | |
Collapse
|