Virtanen Jyrki K, Voutilainen Sari, Happonen Pertti, Alfthan Georg, Kaikkonen Jari, Mursu Jaakko, Rissanen Tiina H, Kaplan George A, Korhonen Maarit J, Sivenius Juhani, Salonen Jukka T
Research Institute of Public Health, University of Kuopio, Kuopio, Finland.
Eur J Cardiovasc Prev Rehabil. 2005 Aug;12(4):369-75. doi: 10.1097/01.hjr.0000160834.75466.b0.
Homocysteine and folate have been suggested to have opposite effects on the risk of stroke, although the results are controversial.
The purpose of this study was to assess the effects of serum total homocysteine (tHcy) and serum folate levels on the risk of stroke in a prospective cohort study. The subjects were 1015 men aged 46-64 years and free of prior stroke, examined in 1991-1993 in the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study.
At baseline the mean serum tHcy concentration was 10.9 micromol/l (SD 3.4). During an average follow-up time of 9.6 years, 49 men experienced a stroke, of which 34 were ischaemic. In Cox proportional hazards models, men in the highest tHcy third had a risk factor-adjusted hazard rate ratio (RR) of 2.77 [95% confidence interval (CI): 1.23-6.24] for any stroke and 2.61 (95% CI: 1.02-6.71) for ischaemic stroke, compared with men in the lowest third. The mean baseline serum folate concentration was 10.4 nmol/l (SD 4.1). Men in the highest third of serum folate (>11.2 nmol/l) had an adjusted RR for any stroke of 0.35 (95% CI: 0.14-0.87) and for ischaemic stroke of 0.40 (95% CI: 0.15-1.09), compared with men in the lowest third.
Elevated serum tHcy is associated with increased risk of all strokes and ischaemic strokes in middle-aged eastern Finnish men free of prior stroke. On the other hand, high serum folate concentration may protect against stroke.
尽管结果存在争议，但有研究表明同型半胱氨酸和叶酸对中风风险有相反的影响。
本研究旨在通过一项前瞻性队列研究评估血清总同型半胱氨酸（tHcy）和血清叶酸水平对中风风险的影响。研究对象为1015名年龄在46 - 64岁且无既往中风史的男性，于1991 - 1993年在库奥皮奥缺血性心脏病危险因素（KIHD）研究中接受检查。
基线时血清tHcy平均浓度为10.9微摩尔/升（标准差3.4）。在平均9.6年的随访期内，49名男性发生中风，其中34例为缺血性中风。在Cox比例风险模型中，与tHcy水平最低三分位的男性相比，tHcy水平最高三分位的男性发生任何中风的风险因素调整后风险率比（RR）为2.77 [95%置信区间（CI）：1.23 - 6.24]，缺血性中风的RR为2.61（95% CI：1.02 - 6.71）。血清叶酸平均基线浓度为10.4纳摩尔/升（标准差4.1）。与叶酸水平最低三分位的男性相比，叶酸水平最高三分位（>11.2纳摩尔/升）的男性发生任何中风的调整后RR为0.35（95% CI：0.14 - 0.87），缺血性中风的RR为0.40（95% CI：0.15 - 1.09）。
血清tHcy升高与无既往中风史的芬兰东部中年男性发生所有中风及缺血性中风的风险增加有关。另一方面，高血清叶酸浓度可能预防中风。
