Xu Richard B, Kong Xiangyi, Xu Benjamin P, Song Yun, Ji Meng, Zhao Min, Huang Xiao, Li Ping, Cheng Xiaoshu, Chen Fang, Zhang Yan, Tang Genfu, Qin Xianhui, Wang Binyan, Hou Fan Fan, Dong Qiang, Chen Yundai, Yang Tianlun, Sun Ningling, Li Xiaoying, Zhao Lianyou, Ge Junbo, Ji Linong, Huo Yong, Li Jianping
Department of Cardiology, Peking University First Hospital, Beijing, China.
National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Am J Clin Nutr. 2017 Mar;105(3):564-570. doi: 10.3945/ajcn.116.145656. Epub 2017 Jan 25.
Diabetes is a known risk factor for stroke, but data on its prospective association with first stroke are limited. Folic acid supplementation has been shown to protect against first stroke, but its role in preventing first stroke in diabetes is unknown. This post hoc analysis of the China Stroke Primary Prevention Trial tested the hypotheses that the fasting blood glucose (FBG) concentration is positively associated with first stroke risk and that folic acid treatment can reduce stroke risk associated with elevated fasting glucose concentrations. This analysis included 20,327 hypertensive adults without a history of stroke or myocardial infarction, who were randomly assigned to a double-blind daily treatment with 10 mg enalapril and 0.8 mg folic acid ( = 10,160) or 10 mg enalapril alone ( = 10,167). Kaplan-Meier survival analysis and Cox proportionate hazard models were used to test the hypotheses with adjustment for pertinent covariables. During a median treatment duration of 4.5 y, 616 participants developed a first stroke (497 ischemic strokes). A high FBG concentration (≥7.0 mmol/L) or diabetes, compared with a low FBG concentration (<5.0 mmol/L), was associated with an increased risk of first stroke (6.0% compared with 2.6%, respectively; HR: 1.9; 95% CI: 1.3, 2.8; < 0.001). Folic acid treatment reduced the risk of stroke across a wide range of FBG concentrations ≥5.0 mmol/L, but risk reduction was greatest in subjects with FBG concentrations ≥7.0 mmol/L or with diabetes (HR: 0.66; 95% CI: 0.46, 0.97; < 0.05). There was a significant interactive effect of FBG and folic acid treatment on first stroke ( = 0.01). In Chinese hypertensive adults, an FBG concentration ≥7.0 mmol/L or diabetes is associated with an increased risk of first stroke; this increased risk is reduced by 34% with folic acid treatment. These findings warrant additional investigation. This trial was registered at clinicaltrials.gov as NCT00794885.
糖尿病是已知的中风风险因素，但关于其与首次中风的前瞻性关联的数据有限。补充叶酸已被证明可预防首次中风，但其在预防糖尿病患者首次中风中的作用尚不清楚。这项对中国中风一级预防试验的事后分析检验了以下假设：空腹血糖（FBG）浓度与首次中风风险呈正相关，叶酸治疗可降低与空腹血糖浓度升高相关的中风风险。该分析纳入了20327名无中风或心肌梗死病史的高血压成年人，他们被随机分配接受每日10毫克依那普利和0.8毫克叶酸的双盲治疗（n = 10160）或仅接受10毫克依那普利治疗（n = 10167）。采用Kaplan-Meier生存分析和Cox比例风险模型对假设进行检验，并对相关协变量进行调整。在中位治疗持续时间4.5年期间，616名参与者发生了首次中风（497例缺血性中风）。与低FBG浓度（<5.0 mmol/L）相比，高FBG浓度（≥7.0 mmol/L）或糖尿病与首次中风风险增加相关（分别为6.0%和2.6%；HR：1.9；95%CI：1.3，2.8；P<0.001）。叶酸治疗降低了FBG浓度≥5.0 mmol/L的广泛范围内的中风风险，但在FBG浓度≥7.0 mmol/L或患有糖尿病的受试者中风险降低最大（HR：0.66；95%CI：0.46，0.97；P<0.05）。FBG和叶酸治疗对首次中风有显著的交互作用（P = 0.01）。在中国高血压成年人中，FBG浓度≥7.0 mmol/L或糖尿病与首次中风风险增加相关；叶酸治疗可使这种增加的风险降低34%。这些发现值得进一步研究。该试验在clinicaltrials.gov上注册为NCT00794885。
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