Abstract
Background: This study aimed to assess the relationship between ideal cardiovascular health (CVH) metrics and incident ischemic stroke (IS) in hypertensive patients, especially those with hyperhomocysteinemia (HHcy).Methods: A prospective cohort study enrolled 5,488 hypertensive patients in Nanshan District of Shenzhen City in southern China from September 2011 to December 2017. CVH metrics were defined according to the American Heart Association. Cox proportional hazards models were used to examine the associations between the number of ideal CVH metrics and the incidence of IS by calculating multivariable-adjusted hazard ratios (HRs) and 95% CI.Results: During an average follow-up of 5.7 years, 340 IS patients were identified. Compared with those having 0 ideal CVH metrics, the HRs (95% CIs) for IS among those with 1, 2, 3, 4, and 5–6 ideal CVH metrics were 0.62 (0.31–1.25), 0.37 (0.19–0.74), 0.37 (0.18–0.74), 0.34 (0.16–0.71), and 0.28 (0.12–0.63), respectively (P < 0.001). An ideal healthy diet score and ideal fasting blood glucose level were independently associated with IS among participants, with HRs (95% CIs) of 0.53 (0.33–0.86) and 0.32 (0.17–0.66), respectively. Additionally, compared with those with normal total homocysteine (tHcy) levels (<15 μmol/L), the HR (95% CI) for IS among participants with HHcy and who had 5–6 ideal CVH metrics was 0.50 (0.27–0.92).Conclusion: An increased number of ideal CVH metrics was inversely associated with the incidence of IS in hypertensive patients. The participants with HHcy who had 5–6 ideal CVH metrics exhibited a lower IS risk than those with normal tHcy levels.
Highlights
Stroke is the leading cause of mortality and disability among adults in China [1] and 87% of stroke-related deaths are caused by ischemic stroke (IS) [2]
Serum uric acid levels were measured by quantitative determination with uricase, plasma total homocysteine levels were measured by the circulating enzyme method, and serum creatinine levels were determined by the Jaffe method using an automatic biochemical analyzer (Hitachi 7080). tHcy levels ≥15 μmol/L was defined as HHcy, according to the Guidelines for Prevention and Treatment of Hypertension in China (2018 Revised Edition) [9]
The cardiovascular health (CVH) metrics adopted in this study were consistent with the CVH metrics proposed by the American Heart Association (AHA), which include seven health behaviors and factors: healthiness of diet, blood pressure (BP), physical activity, BMI, smoking status, Total cholesterol (TC), and fasting blood glucose (FBG) [10]
Summary
Stroke is the leading cause of mortality and disability among adults in China [1] and 87% of stroke-related deaths are caused by ischemic stroke (IS) [2]. The American Heart Association (AHA) has defined ideal cardiovascular health (CVH) metrics. These include four health behaviors [not smoking, a body mass index [BMI] < 24 kg/m2, physical activity at goal levels, and a healthy diet composition], and three health factors (untreated total cholesterol
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