Li Jun-Pei, Cao Tian-Yu, Zha Xiao-Yuan, Yu Yun, Tan Zi-Heng, Cheng Zai-Hua, Ying Hua-Bo, Zhou Wei, Zhu Lin-Juan, Wang Tao, Liu Li-Shun, Bao Hui-Hui, Huang Xiao, Cheng Xiao-Shu
Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China.
University of California, Santa Barbara, CA, USA.
J Geriatr Cardiol. 2022 Jul 28;19(7):522-530. doi: 10.11909/j.issn.1671-5411.2022.07.008.
The cardiovascular hazards of total homocysteine (tHcy) are long known. In addition, despite the acknowledgment on the importance of low ankle-brachial index (ABI) (< 0.9), borderline ABI (0.91-0.99) was once commonly overlooked. This study aims to explore the independent and joint effect of tHcy level and borderline ABI on all-cause death in hypertensive population.
This study included 10,538 participants from China H-type Hypertension Registry Study. ABI was described into two groups: normal ABI (1.00-1.40) and borderline ABI. tHcy level was also divided into two groups: < 15.02 and ≥ 15.02 μmo/L. Four groups were analyzed, using COX proportional hazard regression model, separately and pairwise to observe the independent and joint effect on all-cause death.
A total of 126 (1.2%) deaths were observed in the 1.7 years follow-up time. Borderline ABI has a higher predicted risk of death than normal ABI (HR = 1.87, 95%CI: 1.17-3.00) after adjusting for potential covariates. Compare with tHcy level < 15.02 μmo/L (low tHcy), those with tHcy ≥ 15.02 μmo/L (high tHcy) had higher risk to event outcome (HR = 1.99, 95% CI: 1.30-3.05). According to the cumulative hazard curve, group with borderline ABI and high tHcy level has significantly higher altitude and larger increasing rate over follow-up period compare to other groups. Among those with borderline ABI, participants with high tHcy had higher death risk than those with low tHcy, nevertheless, no significant different between borderline and normal ABI among those with low tHcy levels.
Borderline ABI and tHcy level both have independent predictive value on all-cause death. The combined group of borderline ABI and high tHcy has highest risk factor of outcomes, which suggested the mutual additive value of borderline ABI and tHcy. More attention should be given to the importance of borderline ABI in hypertensive population, especially with elevated tHcy level.
总同型半胱氨酸（tHcy）的心血管危害早已为人所知。此外，尽管人们认识到低踝臂指数（ABI）（<0.9）的重要性，但临界ABI（0.91 - 0.99）曾一度被普遍忽视。本研究旨在探讨tHcy水平和临界ABI对高血压人群全因死亡的独立及联合影响。
本研究纳入了中国H型高血压注册研究的10538名参与者。ABI分为两组：正常ABI（1.00 - 1.40）和临界ABI。tHcy水平也分为两组：<15.02和≥15.02μmol/L。使用COX比例风险回归模型对四组进行单独和两两分析，以观察对全因死亡的独立和联合影响。
在1.7年的随访期内共观察到126例（1.2%）死亡。在调整潜在协变量后，临界ABI的死亡预测风险高于正常ABI（HR = 1.87，95%CI：1.17 - 3.00）。与tHcy水平<15.02μmol/L（低tHcy）相比，tHcy≥15.02μmol/L（高tHcy）的人群发生事件结局的风险更高（HR = 1.99，95%CI：1.30 - 3.05）。根据累积风险曲线，临界ABI和高tHcy水平组在随访期间的风险高度显著高于其他组，且上升速率更大。在临界ABI人群中，高tHcy参与者的死亡风险高于低tHcy参与者，然而，在低tHcy水平人群中，临界ABI和正常ABI之间无显著差异。
临界ABI和tHcy水平对全因死亡均具有独立的预测价值。临界ABI和高tHcy的联合组结局风险因素最高，这表明临界ABI和tHcy具有相互叠加作用。应更加关注临界ABI在高血压人群中的重要性，尤其是在tHcy水平升高的情况下。
