Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China.
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
Hypertens Res. 2023 Jun;46(6):1504-1515. doi: 10.1038/s41440-023-01249-3. Epub 2023 Mar 10.
This study aims to assess the associations of serum and red blood cell (RBC) folate with cardiovascular and all-cause mortality in hypertensive adults. Data on serum and RBC folate from the 1999-2014 National Health and Nutrition Examination Survey were included. Through December 31, 2015, cardiovascular and all-cause mortality were identified from the National Death Index. Multiple Cox regression and restricted cubic spline analyses were used to determine the relationship between folate concentrations and outcomes. A total of 13,986 hypertensive adults were included in the analysis (mean age, 58.5 ± 16.1 years; 6898 [49.3%] men). At a median of 7.0 years of follow-up, 548 cardiovascular deaths and 2726 all-cause deaths were identified. After multivariable adjustment, the fourth quartile of serum folate was associated with cardiovascular (HR = 1.32 [1.02-1.70]) and all-cause (HR = 1.20 [1.07-1.35]) mortality compared to the second quartile, whereas the first quartile was only linked with increased all-cause (HR = 1.29 [1.15-1.46]) mortality. The inflection points for the non-linear associations of serum folate with cardiovascular and all-cause mortality were 12.3 ng/mL and 20.5 ng/mL, respectively. In addition, the highest quartile of RBC folate was associated with cardiovascular (HR = 1.68 [1.30-2.16]) and all-cause (HR = 1.30 [1.16-1.46]) mortality compared to the second quartile, but the lowest quartile was not associated with either outcome. The inflection points for the non-linear associations of RBC folate with cardiovascular and all-cause mortality were 819.7 and 760.1 ng/mL, respectively. The findings suggest non-linear associations between serum and RBC folate levels and the risk of cardiovascular and all-cause mortality in hypertensive adults.
本研究旨在评估血清和红细胞（RBC）叶酸与高血压成年人心血管和全因死亡率的关联。纳入了 1999-2014 年全国健康和营养调查的血清和 RBC 叶酸数据。截至 2015 年 12 月 31 日，通过国家死亡索引确定了心血管和全因死亡率。采用多 Cox 回归和限制立方样条分析来确定叶酸浓度与结局之间的关系。共纳入 13986 例高血压成年人（平均年龄 58.5±16.1 岁；6898[49.3%]为男性）。中位随访 7.0 年后，共确定了 548 例心血管死亡和 2726 例全因死亡。经过多变量调整后，与第二四分位相比，血清叶酸第四四分位与心血管（HR=1.32[1.02-1.70]）和全因（HR=1.20[1.07-1.35]）死亡率相关，而第一四分位仅与全因死亡率增加相关（HR=1.29[1.15-1.46]）。血清叶酸与心血管和全因死亡率的非线性关联的拐点分别为 12.3ng/mL 和 20.5ng/mL。此外，与第二四分位相比，RBC 叶酸的最高四分位与心血管（HR=1.68[1.30-2.16]）和全因（HR=1.30[1.16-1.46]）死亡率相关，但最低四分位与这两种结局均无关。RBC 叶酸与心血管和全因死亡率的非线性关联的拐点分别为 819.7 和 760.1ng/mL。研究结果表明，血清和 RBC 叶酸水平与高血压成年人心血管和全因死亡风险之间存在非线性关联。
