Homocysteine and the risk of ischemic stroke in a triethnic cohort - The Northern Manhattan Study
Homocysteine and the risk of ischemic stroke in a triethnic cohort - The Northern Manhattan Study
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DOI：
10.1161/01.str.0000142374.33919.92
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发表时间：
2004-10-01
期刊：
影响因子：
8.3
通讯作者：
Paik, MC
中科院分区：
文献类型：
--
作者：
Sacco, RL;Anand, K;Paik, MC
背景和目的 - 导致缺血性中风风险的总同型半胱氨酸 (tHcy) 水平尚未确定，并且没有前瞻性队列研究纳入足够的老年少数族裔受试者。我们在一项多种族前瞻性研究中调查了轻度至中度空腹 tHcy 水平与缺血性中风、心肌梗死和血管性死亡发生率之间的关联。方法 - 对基于人群的血管事件（中风、心肌梗死和血管性死亡）队列进行跟踪。测量了 2939 名受试者（平均年龄 69 +/- 10；61% 女性、53% 西班牙裔、24% 黑人和 20% 白人）的 tHcy 和甲基丙二酸基线值。在调整年龄、种族、教育程度、肾功能不全、B-12 缺乏和其他危险因素后，使用 Cox 比例模型计算 tHcy 类别中的风险比 (HR) 和 95% CI。 结果 - 与 < 10 μmol/L 相比，tHcy 水平大于或等于 15 μmol/L 的调整后 HR 对于血管性死亡而言最大（HR = 6.04；95% CI，3.44） 至 10.60），其次是合并血管事件（HR = 2.27；95% CI，1.51 至 3.43）、缺血性卒中（HR = 2.01；95% CI，1.00 至 4.05）和非血管性死亡（HR = 2.02；95% CI，1.31 至 3.14）。 tHcy轻至中度升高10至15 μmol/L并不能显着预测缺血性卒中，但会增加血管性死亡（2.27；95% CI，1.44至3.60）和合并血管事件（1.42；95% CI，1.06至1.88）的风险。 tHcy 在白人和西班牙裔中的影响更强，但对黑人来说并不是显着的危险因素。 结论 - 总 Hcy 升高超过 15 μmol/L 是缺血性中风的独立危险因素，而 tHcy 轻度升高 10 至 15 μmol/L 的预测性较差。 tHcy 对血管的影响在白人和西班牙裔中最大，而在黑人中较小。
Background and Purpose - The level of total homocysteine (tHcy) that confers a risk of ischemic stroke is unsettled, and no prospective cohort studies have included sufficient elderly minority subjects. We investigated the association between mild to moderate fasting tHcy level and the incidence of ischemic stroke, myocardial infarction, and vascular death in a multiethnic prospective study.Methods - A population-based cohort was followed for vascular events ( stroke, myocardial infarction, and vascular death). Baseline values of tHcy and methylmalonic acid were measured among 2939 subjects ( mean age, 69 +/- 10; 61% women, 53% Hispanics, 24% blacks, and 20% whites). Cox proportional models were used to calculate hazard ratios (HRs) and 95% CIs in tHcy categories after adjusting for age, race, education, renal insufficiency, B-12 deficiency, and other risk factors.Results - The adjusted HR for a tHcy level greater than or equal to 15 mumol/L compared with < 10 μmol/L was greatest for vascular death ( HR = 6.04; 95% CI, 3.44 to 10.60), followed by combined vascular events ( HR = 2.27; 95% CI, 1.51 to 3.43), ischemic stroke ( HR = 2.01; 95% CI, 1.00 to 4.05), and nonvascular death ( HR = 2.02; 95% CI, 1.31 to 3.14). Mild to moderate elevations of tHcy of 10 to 15 μmol/L were not significantly predictive of ischemic stroke, but increased the risk of vascular death ( 2.27; 95% CI, 1.44 to 3.60) and combined vascular events (1.42; 95% CI, 1.06 to 1.88). The effect of tHcy was stronger among whites and Hispanics, but not a significant risk factor for blacks.Conclusions - Total Hcy elevations above 15 μmol/L are an independent risk factor for ischemic stroke, whereas mild elevations of tHcy of 10 to 15 μmol/L are less predictive. The vascular effects of tHcy are greatest among whites and Hispanics, and less among blacks.