Wu Zhiyuan, Zhang Haiping, Li Zhiwei, Li Haibin, Miao Xinlei, Pan Huiying, Wang Jinqi, Liu Xiangtong, Kang Xiaoping, Li Xia, Tao Lixin, Guo Xiuhua
Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmen Street, Beijing, 100069 China.
Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
EPMA J. 2022 Sep 26;13(4):581-595. doi: 10.1007/s13167-022-00298-x. eCollection 2022 Dec.
Arterial stiffness is a major risk factor and effective predictor of cardiovascular diseases and a common pathway of pathological vascular impairments. Homocysteine (Hcy) and uric acid (UA) own the shared metabolic pathways to affect vascular function. Serum uric acid (UA) has a great impact on arterial stiffness and cardiovascular risk, while the mutual effect with Hcy remains unknown yet. This study aimed to evaluate the mutual effect of serum Hcy and UA on arterial stiffness and 10-year cardiovascular risk in the general population. From the perspective of predictive, preventive, and personalized medicine (PPPM/3PM), we assumed that combined assessment of Hcy and UA provides a better tool for targeted prevention and personalized intervention of cardiovascular diseases via suppressing arterial stiffness.
This study consisted of 17,697 participants from Beijing Health Management Cohort, who underwent health examination between January 2012 and December 2019. Brachial-ankle pulse wave velocity (baPWV) was used as an index of arterial stiffness.
Individuals with both high Hcy and UA had the highest baPWV, compared with those with low Hcy and low UA (: 30.76, 95% CI: 18.36-43.16 in males; : 53.53, 95% CI: 38.46-68.60 in females). In addition, these individuals owned the highest 10-year cardiovascular risk (OR: 1.49, 95% CI: 1.26-1.76 in males; OR: 7.61, 95% CI: 4.63-12.68 in females). Of note, males with high homocysteine and low uric acid were significantly associated with increased cardiovascular risk (OR: 1.30, 95% CI: 1.15-1.47), but not the high uric acid and low homocysteine group (OR: 1.02, 95% CI: 0.90-1.16).
This study found the significantly mutual effect of Hcy and UA on arterial stiffness and cardiovascular risk using a large population and suggested the clinical importance of combined evaluation and control of Hcy and UA for promoting cardiovascular health. The adverse effect of homocysteine on arteriosclerosis should be addressed beyond uric acid, especially for males. Monitoring of the level of both Hcy and UA provides a window opportunity for PPPM/3PM in the progression of arterial stiffness and prevention of CVD. Hcy provides a novel predictor beyond UA of cardiovascular health to identify individuals at high risk of arterial stiffness for the primary prevention and early treatment of CVD. In the progressive stage of arterial stiffness, active control of Hcy and UA levels from the aspects of dietary behavior and medication treatment is conducive to alleviating the level of arterial stiffness and reducing the risk of CVD. Further studies are needed to evaluate the clinical effect of Hcy and UA targeted intervention on arterial stiffness and cardiovascular health.
The online version contains supplementary material available at 10.1007/s13167-022-00298-x.
动脉僵硬度是心血管疾病的主要危险因素和有效预测指标,也是病理性血管损伤的常见途径。同型半胱氨酸(Hcy)和尿酸(UA)具有共同的代谢途径来影响血管功能。血清尿酸(UA)对动脉僵硬度和心血管风险有很大影响,但其与Hcy的相互作用尚不清楚。本研究旨在评估血清Hcy和UA对一般人群动脉僵硬度和10年心血管风险的相互作用。从预测、预防和个性化医学(PPPM/3PM)的角度来看,我们假设联合评估Hcy和UA可为通过抑制动脉僵硬度来进行心血管疾病的靶向预防和个性化干预提供更好的工具。
本研究纳入了17697名来自北京健康管理队列的参与者,他们在2012年1月至2019年12月期间接受了健康检查。采用肱踝脉搏波速度(baPWV)作为动脉僵硬度指标。
与Hcy和UA水平均低的个体相比,Hcy和UA水平均高的个体baPWV最高(男性:β = 30.76,95%置信区间:18.36 - 43.16;女性:β = 53.53,95%置信区间:38.46 - 68.60)。此外,这些个体的10年心血管风险最高(男性:比值比(OR)= 1.49,95%置信区间:1.26 - 1.76;女性:OR = 7.61,95%置信区间:4.63 - 12.68)。值得注意的是,高同型半胱氨酸和低尿酸的男性与心血管风险增加显著相关(OR = 1.30,95%置信区间:1.15 - 1.47),但高尿酸和低同型半胱氨酸组则不然(OR = 1.02,95%置信区间:0.90 - 1.16)。
本研究使用大量人群发现了Hcy和UA对动脉僵硬度和心血管风险有显著的相互作用,并表明联合评估和控制Hcy和UA对促进心血管健康具有临床重要性。同型半胱氨酸对动脉硬化的不良影响应在尿酸之外加以关注,尤其是对于男性。监测Hcy和UA水平为在动脉僵硬度进展和心血管疾病预防中实施PPPM/3PM提供了一个契机。Hcy为心血管健康提供了一个超越UA的新型预测指标,可识别动脉僵硬度高风险个体以进行心血管疾病的一级预防和早期治疗。在动脉僵硬度进展阶段,从饮食行为和药物治疗等方面积极控制Hcy和UA水平有利于减轻动脉僵硬度水平并降低心血管疾病风险。需要进一步研究来评估针对Hcy和UA的干预对动脉僵硬度和心血管健康的临床效果。
在线版本包含可在10.1007/s13167 - 022 - 00298 - x获取的补充材料。