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Status of hyperhomocysteinemia in China: results from the China Stroke High-risk Population Screening Program, 2018
Wenjun Tu1,2,3, Feng Yan4, Baohua Chao2
1Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300192, China.
Insights
Hyperhomocysteinemia (Hhcy) affects 25.9% of Chinese adults over 40, with prevalence varying by region. Elevated serum homocysteine (HCY) is linked to lifestyle and health factors, and H-type hypertension (HHYP) predicts stroke risk.
Area of Science:
- Cardiovascular Epidemiology
- Public Health Research
- Clinical Biochemistry
Background:
- Hyperhomocysteinemia (Hhcy), characterized by elevated serum homocysteine (HCY) levels, is a recognized risk factor for cardiovascular diseases.
- Understanding the prevalence and determinants of Hhcy is crucial for developing targeted public health interventions in diverse populations.
Purpose of the Study:
- To determine the prevalence of Hhcy and H-type hypertension (HHYP) across China.
- To identify factors influencing serum HCY levels in the adult population.
- To assess the association between HHYP and stroke risk.
Main Methods:
- A nationwide cross-sectional survey was conducted from October 2018 to September 2019.
- A standardized questionnaire collected demographic, lifestyle, and health data from 110,551 residents aged 40 and above.
- Serum HCY levels were measured, with Hhcy defined as ⩾ 15.0µmol/L and HHYP as hypertension with elevated HCY.
Main Results:
- The overall prevalence of Hhcy was 25.9% (median HCY: 10.9µmol/L), with significant geographical variation (7.9% in Shanghai to 56.8% in Tianjin).
- Serum HCY levels were associated with older age, male gender, smoking, hypertension, diabetes, ethnicity, and inversely with exercise and fruit/vegetable intake.
- H-type hypertension (HHYP) was identified in 14.0% of participants and was an independent predictor of stroke (adjusted OR: 1.752).
Conclusions:
- Hhcy represents a significant public health issue in China, with considerable regional disparities.
- Lifestyle modifications and management of hypertension and diabetes are key to controlling HCY levels.
- National strategies are needed to address the Hhcy epidemic and improve patient care, particularly given its association with stroke risk.
Abstract:
A nationwide survey was conducted from October 2018 to September 2019 to assess the prevalence of hyperhomocysteinemia (Hhcy) and its influencing factors in China. A standardized questionnaire was used to collect information. Hhcy was defined as the level of serum homocysteine (HCY) ⩾ 15.0µmol/L. The H-type hypertension (HHYP) was defined as hypertension with an elevated serum HCY 15.0µmol/L). Finally, 110 551 residents ⩾ 40 years of age from 31 provinces in the mainland of China were included. Overall, the median serum HCY level was 10.9µmol/L (interquartile range 7.9-15.1). A total of 28 633 participants (25.9%) were defined as Hhcy. The Hhcy prevalence ranged from 7.9% in Shanghai to 56.8% in Tianjin. The data showed that serum HCY levels were associated with age, male gender, cigarette smoking, hypertension, diabetes, ethnicity, endurance in exercise (inverse), and fruit and vegetable intake (inverse). In addition, 15 486 participants were defined as HHYP, and the rate was 14.0%. HHYP was an independent predictor of stroke with an adjusted odds ratio of 1.752 (95% CI 1.338-2.105). The geographical distribution pattern of the Hhcy epidemic reflects dynamic differences, and national strategies should be carried out to further improve the care of patients with Hhcy across China.
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