Li Jing, Zhang Jianan, Chen Yan, Gao Linglin, Yan Xiaoluan, Zhang Mingzhi, Wang Fenchun, He Yan, Hu Weidong, Peng Hao
Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China.
Department of Chronic Disease Management, Taicang Center for Disease Prevention and Control, Taicing, China.
Nutr Metab Cardiovasc Dis. 2023 Jan;33(1):194-202. doi: 10.1016/j.numecd.2022.10.013. Epub 2022 Oct 29.
The effect of reductions in homocysteine (Hcy) on cardiovascular disease (CVD) was suggested to be modified by platelet activation, but the interaction between Hcy and platelet activation on CVD events is not well studied. Here, we aimed to examine the interaction between Hcy and platelet activation on CVD in a large, real-world population.
A total of 27,234 patients with hypertension (mean 63 years, 48% male) who were registered in Taicang city and free of CVD were prospectively followed up for new CVD events from 2017 to 2020. Hcy and platelet indices including mean platelet volume (MPV) were assayed at baseline. A total of 1063 CVD events were recorded during follow-up. Hcy at baseline was significantly associated with a higher risk of CVD (HR = 1.85, P < 0.001 for log-transformed Hcy). MPV showed a significant interaction effect with Hcy on CVD (HR = 1.20, P = 0.030 for the interaction term). The association between Hcy and CVD was significantly stronger in participants with a large (vs. small) MPV (HR = 2.71 vs. 1.32, P = 0.029 for log-transformed Hcy). For participants with both elevated Hcy and a large MPV, the attributable proportion of CVD events due to their interaction was 0.26 (95% CI: 0.06-0.45).
The association between Hcy and CVD was significantly stronger in patients with hypertension with a larger MPV. MPV may modify the contribution of Hcy to CVD events through synergistic interactions with Hcy. These findings suggest that MPV could be monitored and controlled in the prevention of CVD.
同型半胱氨酸（Hcy）降低对心血管疾病（CVD）的影响被认为会因血小板活化而改变，但Hcy与血小板活化在CVD事件上的相互作用尚未得到充分研究。在此，我们旨在研究在一个大型真实世界人群中Hcy与血小板活化在CVD方面的相互作用。
对太仓市登记的27234例高血压患者（平均63岁，48%为男性）进行前瞻性随访，这些患者无CVD，随访其2017年至2020年的新发CVD事件。在基线时检测Hcy和血小板指标，包括平均血小板体积（MPV）。随访期间共记录到1063例CVD事件。基线时的Hcy与较高的CVD风险显著相关（对数转换后的Hcy的HR = 1.85，P < 0.001）。MPV在CVD方面与Hcy显示出显著的相互作用效应（相互作用项的HR = 1.20，P = 0.030）。在MPV大（与小相比）的参与者中，Hcy与CVD之间的关联显著更强（对数转换后的Hcy的HR = 2.71对1.32，P = 0.029）。对于Hcy升高且MPV大的参与者，由于它们的相互作用导致的CVD事件归因比例为0.26（95%CI：0.06 - 0.45）。
在MPV较大的高血压患者中，Hcy与CVD之间的关联显著更强。MPV可能通过与Hcy的协同相互作用改变Hcy对CVD事件的影响。这些发现表明，在预防CVD时可监测和控制MPV。
