Abstract
Previous studies have focused mostly on independent effects of the stroke risk factors, whereas little attention has been paid to interactions between individual factors which may be important for stroke prevention. We collected data related to the patients’ demographic characteristics, history of chronic diseases and lifestyle factors in 2258 patients with primary hypertension. Logistic regression models based on odds ratio (OR) with their associated 95% confidence interval (CI) were used to estimate an independent effect of homocysteine (Hcy) on the risk of stroke but also include the interactions between Hcy and other risk factors. Hcy was associated with an increased OR of the risk of stroke in both hypertension patients (OR, 1.027; 95% CI, 1.016–1.038; P < 0.001) and H-type hypertension patients (OR, 1.026; 95% CI, 1.014–1.037; P < 0.001), after adjustment for potential confounding factors. Among the hypertension participants, three tests of interactions between Hcy and other risk factors were statistically significant: sex, systolic blood pressure and diastolic blood pressure. In conclusion, complexities of the interactions of Hcy stratified by sex and blood pressure need to be considered in predicting overall risk and selecting certain treatments for stroke prevention.
Highlights
In all 33 province-level administrative units in mainland China, cerebrovascular disease as the most common non-communicable disease, contributed much more to years of life lost in 20131
In HHcy group, hypertension patients with stroke had the significantly higher fasting plasma glucose (FPG), systolic blood pressure (SBP), diastolic blood pressure (DBP), and estimated glomerular filtration rate (eGFR) levels than those of patients without stroke, and diabetes mellitus (DM) was noted in 30.95% of individuals with stroke compared to 14.80% without stroke
The univariate logistic regression analysis revealed that Hcy was associated with an increased odds ratio (OR) of the risk of stroke in both 2258 hypertension patients (OR, 1.027; 95% confidence interval (CI), 1.016–1.038; P < 0.001) and 1920 H-type hypertension patients (OR, 1.026; 95% CI, 1.014–1.037; P < 0.001), after adjustment for age, sex, body mass index (BMI), SBP, DBP, FPG, total cholesterol (TC), TG, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, serum creatinine (sCr), eGFR and history of smoking, alcohol intake, DM, and hyperlipidemia
Summary
In all 33 province-level administrative units in mainland China, cerebrovascular disease as the most common non-communicable disease, contributed much more to years of life lost in 20131. The China Stroke Primary Prevention Trial (CSPPT) trial was performed in hypertensive patients and demonstrated a positive effect in reducing risk of stroke[4]. Hyperhomocysteinemia (HHcy) has been widely accepted as a risk factor for stroke[5]. Extensive clinical and preclinical data support HHcy as an independent predictor of vascular contributions to cognitive impairment and dementia[6], cerebral vascular resistance[7], asymptomatic carotid stenosis[8]. Because of the known association of hypertension with both HHcy and stroke, we stratified the analyses by the level of conventional predisposing factors on risk of stroke and determined whether the plasma Hcy levels were associated with stroke. Interactions between elevated Hcy and cardiovascular risk factors were detected
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