Abstract
Objective: Arterial hypertension is a risk factor for cardiovascular (CV) events, including stroke. High blood homocysteine levels (hyperhomocysteinemia) are also considered to increase CV risk and are associated with vitamin B12 deficiency that possibly increase CV and stroke risk, as well. The present study assessed the possible relation of high homocysteine and low vitamin B12 levels with the underlying CV and stroke risk of hypertensive patients. Design and method: This retrospective study comprised all hypertensives referred to our institutions and had a blood sample measurement of homocysteine and B12 (n = 32800). The 10-year fatal CV risk and stroke risk were calculated with the HeartScore and the FraminghamStrokeScore, respectively. The population was divided in quartiles according to homocysteine levels (groups 1, 2, 3 and 4 for increasing levels) and B12 levels (groups 1, 2, 3 and 4 for decreasing levels). Cardiovascular and stroke risk were calculated for each homocysteine and B12 quartile group as well as for each of the 16 homocysteine/B12 combination quartile subgroups. Results: The mean values for homocysteine were 13.3 ± 7.2 μmol/l and for B12 525 ± 196 pg/ml. For homocysteine quartiles 1, 2, 3, 4, CV risk was 3.4%, 5.5%, 9.0%, 17.9%, respectively (pfor trend 0.05). For B12 quartiles 1, 2, 3, 4, CV risk was 3.0%, 6.2%, 9.5%, 15.1%, respectively (pfor trend 0.01). Correlation coefficient ® between homocysteine and CV risk values was 0.416 (p < 0.0001) while between B12 and CV risk values was -0.369 (p < 0.0001). For homocysteine quartiles 1, 2, 3, 4, stroke risk was 4.2%, 7.3%, 12.9%, 25.0%, respectively (pfor trend 0.04). For B12 quartiles 1, 2, 3, 4, stroke risk was 5.4%, 9.2%, 13.4%, 19.3%, respectively (pfor trend 0.08). Correlation coefficient ® between homocysteine and stroke risk values was 0.474 (p < 0.0001) while between B12 and stroke risk values was -0.348 (p < 0.0001). The synergistic effect of increasing homocysteine and decreasing B12 values on CV and stroke risk increase is presented in Figure. Conclusions: High homocysteine levels and low vitamin B12 levels are individually and synergistically associated with the underlying CV and stroke risk of hypertensive individuals. Possible mechanisms merit further examination.
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