背景:大约75%的中国高血压患者的同型半胱氨酸(Hcy)升高。其在首次中风的风险评估和预防中的意义仍然是重要的临床和公共卫生问题。
方法:本研究基于2016年至2018年在中国农村招募的社区队列。为了最大限度地提高成本效率,我们使用了嵌套的案例控制设计,包括3,533例首次中风病例和3,533例年龄±1岁相匹配的对照,性别,和村庄。研究了tHcy和传统危险因素与首次卒中的个体关联,并对其人群归因风险(PAR)进行了估计。
结果:首次卒中与总Hcy(tHcy)水平之间存在显着的剂量反应相关性,tHcy10-15μmol/L的调整比值比为1.11(95%CI:0.97,1.26),tHcy≥15μmol/L的调整比值比为1.44(1.22,1.69),所有tHcy<10μmol/L缺血性和出血性中风也有类似的趋势。tHcy和收缩压(SBP)与首次卒中的风险独立且相加相关(tHcy:1.06[1.02,1.1];SBP:1.13[1.1,1.16];P-交互作用,0.889)。在所检查的十个主要风险因素中,第一次中风的前两个贡献者是SBP和tHcy,PAR分别为25.73和11.24%,分别。
结论:tHcy升高是第二重要因素,并与SBP共同作用,增加首次卒中的风险。这一发现强调了筛查和治疗tHcy升高以及传统危险因素的重要性,以进一步减轻高危人群中首次中风的负担。
BACKGROUND: Approximately 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.
METHODS: This 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.
RESULTS: There 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.
CONCLUSIONS: Elevated 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.