Association between homocysteine and incidence of ischemic stroke in subjects with essential hypertension: A matched case-control study

Abstract

Background: To assess the association between total plasma homocysteine (tHcy) and ischemic stroke (IS) in hypertensive subjects in a matched case-control study. Methods: This is a 1:2 matched and population-based case-control study, all of the participants were recruited from the 60 communities in Shenzhen, China. Demographic and socioeconomic characteristics, medical records, lifestyle risk factors and other clinical characteristics were obtained from all of the subjects. The association between tHcy and incidence of IS was analyzed by using conditional logistic regression models. Results: The median values of plasma tHcy were significantly higher in IS subjects than in non-IS subjects, especially in women. After adjusted for the confounding factors in Model 2, compared with the lowest quartile of tHcy, the odds ratios (ORs) and 95% CIs of the highest quartile of tHcy for IS were 0.83 (0.36–1.90) in men, 4.51 (1.29–15.7) in women and 1.31 (0.70–2.47) in the total subjects; the ORs and 95% CIs for IS per 5 μmol/L increase in homocysteine were 1.11 (0.99–1.22), 1.25 (1.03–1.58) and 1.15 (1.01–1.28) in men, women and total subjects, respectively. We observed significant associations in crude model, Model 1 and Model 2 in women for the comparison of tHcy ≥ 15 μmol/L versus < 15 μmol/L. Interaction analysis showed that the association of tHcy with IS was significant in women (p-interaction = 0.04). Conclusion: This matched case-control study indicates that tHcy may increase the susceptibility to IS in essential hypertension subjects, especially in women. Further large prospective cohort studies are needed to confirm our findings.

• Association study, case-control study, essential hypertension, homocysteine, ischemic stroke

Acknowledgements

We are grateful for the help of the doctors and nurses in the above-mentioned health centers in data and sample collection.

Declaration of interest

The authors declared no conflict of interest.

The research was supported by grants from: Shenzhen Nanshan Bureau of Science and Technology (2013067), the National Natural Science Foundation of China (81373094 and 81402745), the Natural Science Foundation of Ningbo City (2011A610037 and 2014A610268), the Natural Science Foundation of Zhejiang Province (LR13H020003 and LQ13H260002), Zhejiang Province Scientific Research Projects of Education (Y201326971), the Ministry of Education, Humanities and Social Sciences project (14YJC630046), Ningbo University Scientific Research Fund (XKl1349 and XKL14D2095).