Abstract
L-α glycerylphosphorylcholine (α-GPC, choline alphoscerate) is used globally by individuals older than 50 years based on its potential function as a precursor of acetylcholine. However, choline has previously been linked to a higher risk of cardiovascular disease via trimethylamine-N-oxide, a metabolite of choline by microbiota. To investigate the association between α-GPC use and subsequent 10-year stroke risk. A population-based, retrospective cohort study was conducted using data from the National Health Insurance Service of South Korea. Participants included men and women aged 50 years or older without underlying stroke or Alzheimer disease (N = 12 008 977). All participants were divided into whether they were prescribed α-GPC during 2006-2008. α-GPC users were matched with nonusers for all covariates to create a matched cohort. α-GPC use was further divided into durations less than 2, 2 to 6, 6 to 12, and more than 12 months of α-GPC prescriptions. The adjusted hazard ratios (aHRs) and 95% CIs for total stroke, ischemic stroke, and hemorrhagic stroke from January 1, 2009, to January 31, 2018, were calculated by multivariate Cox proportional hazards regression. A total of 12 008 977 individuals (6 401 965 [53.3%] women) aged 50 years or older were included in the study. The mean (SD) age was 61.6 (9.4) years for nonusers and 68.3 (10.0) years for users, and that of the matching cohort was 68.2 (9.9) years for both groups. Compared with α-GPC nonusers (n = 11 900 100), users (n = 108 877) had a higher risk for total stroke (aHR, 1.46; 95% CI, 1.43-1.48), ischemic stroke (aHR 1.36; 95% CI, 1.33-1.39), and hemorrhagic stroke (aHR, 1.36; 95% CI, 1.28-1.44). After matching for all covariates, α-GPC users had a higher risk for total stroke (aHR, 1.43; 95% CI, 1.41-1.46), ischemic stroke (aHR, 1.34; 95% CI, 1.31-1.37), and hemorrhagic stroke (aHR, 1.37; 95% CI, 1.29-1.46). Increasing intake of α-GPC was associated with a higher risk for total stroke in a dose-response manner. In this cohort study, use of α-GPC was associated with a higher 10-year incident stroke risk in a dose-response manner after adjusting for traditional cerebrovascular risk factors. Future studies are needed to determine the possible mechanisms behind the potential cerebrovascular risk-elevating effects of α-GPC.
Highlights
The prevalence of dementia among the older population approximately doubles every 5 years,[1] with 131 million adults worldwide expected to be diagnosed with dementia by 2050.2 The goals of dementia management are to treat symptoms associated with cognitive decline and changes in mood and behavior in an attempt to delay progressive cognitive decline.[3]
After matching for all covariates, α glycerylphosphorylcholine (α-GPC) users had a higher risk for total stroke, ischemic stroke, and hemorrhagic stroke
Future studies are needed to determine the possible mechanisms behind the potential cerebrovascular risk–elevating effects of α-GPC
Summary
The prevalence of dementia among the older population approximately doubles every 5 years,[1] with 131 million adults worldwide expected to be diagnosed with dementia by 2050.2 The goals of dementia management are to treat symptoms associated with cognitive decline and changes in mood and behavior in an attempt to delay progressive cognitive decline.[3]. The discrepancies of approving α-GPC as a prescription drug between countries appear to suggest that there may be a lack of sufficient evidence on its efficacy, safety, or both. A metabolite of α-GPC,[7] is an essential nutrient that is naturally present in some foods and supplements,[8] with potential adverse effects such as fishy body odor, vomiting, excessive sweating and salivation, hypotension, and liver diseases.[8,9] a growing body of evidence suggests that a high plasma choline level is associated with a high risk of cardiovascular disease via trimethylamine-N-oxide (TMAO) produced by gut microbiota from choline.[10,11,12,13] Some studies suggest that TMAO is associated with stroke as well as cardiovascular disease.[14,15,16]
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