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Threshold effect of plasma total homocysteine levels on cognitive function among hypertensive patients in China: A

Li Wang1,2,3, Jianduan Chen4, Junpei Li1,2,3

  • 1Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.

Frontiers in Neurology
|September 5, 2022
PubMed

Insights

High homocysteine (tHcy) levels are linked to cognitive decline in hypertensive patients. A threshold effect exists, with levels above 27.1 μmol/L showing a weaker association with cognitive function.

Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Biochemistry

Background:

  • Elevated plasma total homocysteine (tHcy) is a known risk factor for cognitive impairment.
  • Limited research exists on the tHcy-cognitive function relationship in hypertensive populations.
  • This study investigates this association in Chinese hypertensive patients.

Purpose of the Study:

  • To explore the association between plasma tHcy levels and cognitive function in hypertensive patients.
  • To identify potential thresholds for tHcy levels impacting cognitive assessment scores (MMSE).
  • To examine sex-specific differences in the tHcy-cognitive function relationship.

Main Methods:

  • Analysis of 9,527 hypertensive adults from the Chinese Hypertension Registry Study.
  • Quantification of plasma tHcy using high-performance liquid chromatography.
  • Cognitive function assessed via Mini-Mental State Examination (MMSE) scores.
  • Statistical analysis including linear regression, piecewise linear regression, and smoothing curve fitting.

Main Results:

  • A significant negative association was found between plasma tHcy levels and MMSE scores (β per SD increase: -0.26, P < 0.001).
  • A nonlinear relationship with a threshold effect was observed, with an inflection point at approximately 27.1 μmol/L.
  • The inverse association was stronger below the threshold (β = -0.93) than above it (β = -0.07).
  • Sex influenced the association, with a stronger inverse relationship in females below 26.9 μmol/L compared to males below 32.0 μmol/L.

Conclusions:

  • Plasma tHcy levels exhibit a threshold effect on cognitive function (MMSE scores) in Chinese hypertensive patients.
  • Increased plasma tHcy is independently and inversely associated with cognitive decline in hypertensive individuals with tHcy concentrations below 27.1 μmol/L.
  • Sex modifies this association, particularly at lower tHcy levels.
Abstract

Keywords:
Mini-Mental State Examinationcognitive functionhypertensionthreshold effecttotal homocysteine

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