Association Between Folic Acid Supplementation and Retinal Atherosclerosis in Chinese Adults With Hypertension Complicated by Diabetes Mellitus.

Ying Meng,Yong Huo,Rongfeng Liao,Haibo Li,Kun Shang,Fanfan Hou,Xiaopeng Gu,Haicheng She,Xianhui Qin,Yuan Peng,Liu Yang,Xuling Chen,Jun Li,Xiping Xu,Jing Zhang,Liang Zhao,Jianping Li,Yuanyuan Zhang ,Wen‐Bin Yang ,Xiaogang Zhang ,Guping Tang

doi:10.3389/fphar.2018.01159

Abstract

Background: This cross-section investigation included 2,199 participants with hypertension complicated by diabetes mellitus, a cohort of the China Stroke Primary Prevention Trial in which 20,702 patients with essential hypertension were given enalapril with folic acid or enalapril-only double-blind treatment for 5 years. This study aimed to explore the correlation between folic acid supplementation and retinal atherosclerosis (RA) in adults with hypertension complicated by diabetes mellitus.Methods: The diagnosis of RA was determined by non-mydriatic fundus photography and classified by the Keith-Wagener-Barker system. The statistical correlation of folic acid supplementation with RA prevalence and severity was assessed.Results: Of our cohort, 1,698 (77.6%) participants were diagnosed with RA, and the prevalence in males and females was 78.0 and 75.6%, respectively. Participants in the enalapril group had higher total homocysteine (tHcy) levels than those in enalapril–folic acid group. Compared with the enalapril group in the tHcy > 15 μmol/L group of females, the odds ratio for the enalapril–folic acid group was 0.28 (95% confidence interval, 0.11–0.67, P = 0.0061).Conclusions: The prevalence of RA was high (77.6%) in our cohort of adults with hypertension complicated by diabetes mellitus. Folic acid supplementation was significantly associated with reduced risk of RA in females with hyperhomocysteinemia. No significant association were seen in males.

Highlights

Hypertension and diabetes cause noninfectious and retrograde pathological changes, or atherosclerosis, in the retinal arteries
Our results provide valuable information about the epidemiology of retinal atherosclerosis (RA) in a population with hypertension complicated by diabetes mellitus
This cross-sectional study of 2,199 participants with hypertension complicated by diabetes mellitus showed a positive correlation between folic acid supplementation and the risk of RA in females with hyperhomocysteinemia

Summary

Introduction

Hypertension and diabetes cause noninfectious and retrograde pathological changes, or atherosclerosis, in the retinal arteries Those changes are closely related to pathological changes in the vessels of other organs. Many studies show that hypertension and high Hcy levels have synergistic effect in causing cardiovascular and cerebrovascular events (Bortolotto et al, 1999; Sharabi et al, 1999; Han et al, 2015). Reducing BP or Hcy level alone may not be sufficient to reduce the risk of cardiovascular and cerebrovascular events. This cross-section investigation included 2,199 participants with hypertension complicated by diabetes mellitus, a cohort of the China Stroke Primary Prevention Trial in which 20,702 patients with essential hypertension were given enalapril with folic acid or enalapril-only double-blind treatment for 5 years. This study aimed to explore the correlation between folic acid supplementation and retinal atherosclerosis (RA) in adults with hypertension complicated by diabetes mellitus

Objectives

Methods

Results