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Association between percent decline in serum total homocysteine and risk of first stroke

Xiao Huang1, Youbao Li1, Ping Li1

  • 1From the Department of Cardiology (X.H., P.L., H.B., X.C.), Second Affiliated Hospital, Nanchang University; Division of Nephrology (Y.L., B.W., F.F.H., X.Q.), Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease (Y.L., B.W., F.F.H., X.Q.); State Key Laboratory of Organ Failure Research (Y.L., B.W., F.F.H., X.Q.); Guangdong Provincial Institute of Nephrology (Y.L., B.W., F.F.H., X.Q.); Departments of Cardiology (J.L., Y.Z., Y. Huo), Pharmacy (Y. Cui), and Neurology (Y. Huang), Peking University First Hospital; Department of Cardiology (N.S.), Peking University People's Hospital, Beijing; Department of Hypertension (J.W.), The Shanghai Institute of Hypertension, Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai; Departments of Neurology (M.H.) and Cardiology (D.Y.), First People's Hospital, Lianyungang; Institute for Biomedicine and School of Health Administration (G.T.), Anhui Medical University, Hefei; and Department of Cardiology (Y. Chen), Chinese PLA General Hospital, Beijing, China.

Neurology
|October 15, 2017
PubMed

Insights

Reducing serum total homocysteine (tHcy) levels is linked to a lower risk of first stroke in Chinese adults. This finding suggests that tHcy reduction may indicate the effectiveness of folic acid in stroke prevention.

Area of Science:

  • Cardiovascular Research
  • Neurology
  • Clinical Trials

Background:

  • The China Stroke Primary Prevention Trial (CSPPT) investigated stroke prevention strategies.
  • Serum total homocysteine (tHcy) is a potential risk factor for cardiovascular events.
  • Understanding the impact of tHcy reduction on stroke risk is crucial for public health.

Purpose of the Study:

  • To determine if changes in serum total homocysteine (tHcy) levels correlate with the risk of experiencing a first stroke.
  • To analyze the association between the percentage decline in tHcy and stroke incidence within the CSPPT cohort.

Main Methods:

  • Analysis of 16,867 participants from the CSPPT with baseline and exit tHcy measurements.
  • Primary outcome: first-ever stroke. Secondary outcome: composite of cardiovascular events.
  • Calculation of percent tHcy decline: [(baseline tHcy - exit tHcy)/baseline tHcy × 100].

Main Results:

  • Participants with a first stroke showed a significantly lower percent decline in tHcy compared to those without stroke.
  • A 20% reduction in tHcy was associated with a 7% decrease in stroke risk (HR 0.93).
  • Greater tHcy reduction (tertiles 2-3) significantly lowered stroke risk, with benefits observed across various demographic and clinical subgroups.

Conclusions:

  • A significant association exists between percent lowering of serum tHcy and reduced first stroke risk in Chinese adults with hypertension.
  • Further confirmation may establish tHcy reduction as a valuable marker for folic acid treatment efficacy in stroke prevention.
Abstract

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