医学
亚甲基四氢叶酸还原酶
同型半胱氨酸
冲程(发动机)
内科学
危险系数
依那普利
基因型
胃肠病学
置信区间
血压
血管紧张素转换酶
生物化学
生物
机械工程
基因
工程类
作者
Min Zhao,Xiaobin Wang,Minqiang He,Xianhui Qin,Genfu Tang,Yong Huo,Jianping Li,Fu Jia,Xiao Huang,Xiaoshu Cheng,Yuanyuan Zhang,Fan Fan Hou,Ning Sun,Yefeng Cai
出处
期刊:Stroke
[Ovid Technologies (Wolters Kluwer)]
日期:2017-05-01
卷期号:48 (5): 1183-1190
被引量:87
标识
DOI:10.1161/strokeaha.116.015324
摘要
Elevated blood homocysteine concentration increases the risk of stroke, especially among hypertensive individuals. Homocysteine is largely affected by the methylenetetrahydrofolate reductase C677T polymorphism and folate status. Among hypertensive patients, we aimed to test the hypothesis that the association between homocysteine and stroke can be modified by the methylenetetrahydrofolate reductase C677T polymorphism and folic acid intervention.We analyzed the data of 20 424 hypertensive adults enrolled in the China Stroke Primary Prevention Trial. The participants, first stratified by methylenetetrahydrofolate reductase genotype, were randomly assigned to receive double-blind treatments of 10-mg enalapril and 0.8-mg folic acid or 10-mg enalapril only. The participants were followed up for a median of 4.5 years.In the control group, baseline log-transformed homocysteine was associated with an increased risk of first stroke among participants with the CC/CT genotype (hazard ratio, 3.1; 1.1-9.2), but not among participants with the TT genotype (hazard ratio, 0.7; 0.2-2.1), indicating a significant gene-homocysteine interaction (P=0.008). In the folic acid intervention group, homocysteine showed no significant effect on stroke regardless of genotype. Consistently, folic acid intervention significantly reduced stroke risk in participants with CC/CT genotypes and high homocysteine levels (tertile 3; hazard ratio, 0.73; 0.55-0.97).In Chinese hypertensive patients, the effect of homocysteine on the first stroke was significantly modified by the methylenetetrahydrofolate reductase C677T genotype and folic acid supplementation. Such information may help to more precisely predict stroke risk and develop folic acid interventions tailored to individual genetic background and nutritional status.URL: http://www.clinicaltrials.gov. Unique identifier: NCT00794885.
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