Association between homocysteine and conventional predisposing factors on risk of stroke in patients with hypertension

Abstract

Previous studies have focused mostly on independent effects of the stroke risk factors, whereas little attention has been paid to interactions between individual factors which may be important for stroke prevention. We collected data related to the patients' demographic characteristics, history of chronic diseases and lifestyle factors in 2258 patients with primary hypertension. Logistic regression models based on odds ratio (OR) with their associated 95% confidence interval (CI) were used to estimate an independent effect of homocysteine (Hcy) on the risk of stroke but also include the interactions between Hcy and other risk factors. Hcy was associated with an increased OR of the risk of stroke in both hypertension patients (OR, 1.027; 95% CI, 1.016-1.038; P < 0.001) and H-type hypertension patients (OR, 1.026; 95% CI, 1.014-1.037; P < 0.001), after adjustment for potential confounding factors. Among the hypertension participants, three tests of interactions between Hcy and other risk factors were statistically significant: sex, systolic blood pressure and diastolic blood pressure. In conclusion, complexities of the interactions of Hcy stratified by sex and blood pressure need to be considered in predicting overall risk and selecting certain treatments for stroke prevention.

Figure 1

Interaction of homocysteine (Hcy) and sex on stroke risk. Among three different levels of Log Hcy in 2258 patients with hypertension, the prevalence of stroke in female (77.16%) was highest in those with Log Hcy level >1.23.

Figure 2

Interaction of homocysteine (Hcy) and systolic blood pressure (SBP) on stroke risk. Among three different levels of Log Hcy in 2258 patients with hypertension, those with both Log Hcy level >1.23 and SBP ≥180 mmHg were found to have the highest stroke morbidity (98.74%).

Figure 3

Interaction of homocysteine (Hcy) and diastolic blood pressure (DBP) on stroke risk. Among three different levels of Log Hcy in 2258 patients with hypertension, those with both Log Hcy level >1.23 and DBP ≥110 mmHg were found to have the highest stroke morbidity (98.06%).