Abstract
BackgroundApproximately 75% of Chinese hypertensive patients have elevated homocysteine (Hcy). Its implication in risk assessment and prevention of the first stroke remains an important clinical and public health question.MethodsThis study was based on a community cohort recruited from 2016 to 2018 in the rural China. To maximize cost efficiency, we used a nested case-control design, including 3,533 first stroke cases and 3,533 controls matched for age ±1 years, sex, and village. Individual associations of tHcy and traditional risk factors with the first stroke were examined, and their population-attributable risks (PARs) were estimated.ResultsThere was a significant dose-response association between first stroke and total Hcy (tHcy) levels, with adjusted odds ratios of 1.11 (95% CI: 0.97, 1.26) for tHcy 10–15 μmol/L and 1.44 (1.22, 1.69) for tHcy ≥ 15 μmol/L, all compared to tHcy < 10 μmol/L. A similar trend was found for ischemic and hemorrhagic stroke. tHcy and systolic blood pressure (SBP) were independently and additively associated with the risk of first stroke (tHcy: 1.06 [1.02, 1.1]; SBP: 1.13 [1.1, 1.16]; P-interaction, 0.889). Among the ten main risk factors examined, the top two contributors to the first stroke were SBP and tHcy, with PARs of 25.73 and 11.24%, respectively.ConclusionsElevated tHcy is the second most important contributor and acts additively with SBP to increase the risk of the first stroke. This finding underscores the importance of screening and treating elevated tHcy along with traditional risk factors to further reduce the burden of the first stroke in the high-risk populations.
Highlights
Stroke is the second leading cause of death and disability worldwide and the leading cause of death in China [1]
The independent and interactive impacts of HHcy and hypertension on cardiovascular diseases have been previously reported [9, 10], few recent studies have been conducted to quantify the relative effect of HHcy, in the context of traditional risk factors, on the first stroke, ischemic stroke, and hemorrhagic stroke, especially among rural Chinese community populations who have a disproportionately high burden of stroke and its severe health and economic sequala
The mean age at blood sample collection was 67.9 (SD, 9.3) years for first stroke cases and 67.8 (SD, 9.3) years for controls; females made up 55.3%
Summary
Stroke is the second leading cause of death and disability worldwide and the leading cause of death in China [1]. While stroke in China share traditional risk factors, the high and escalating stroke rate urges us to investigate distinctive feature of stroke epidemiology in China and identify additional intervention targets [5]. A unique and well-observed clinical feature is that approximately 75% of Chinese hypertensive patients have hyperhomocysteinemia (HHcy) [7]. The independent and interactive impacts of HHcy and hypertension on cardiovascular diseases have been previously reported [9, 10], few recent studies have been conducted to quantify the relative effect of HHcy, in the context of traditional risk factors, on the first stroke, ischemic stroke, and hemorrhagic stroke, especially among rural Chinese community populations who have a disproportionately high burden of stroke and its severe health and economic sequala. Its implication in risk assessment and prevention of the first stroke remains an important clinical and public health question
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