Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology Suzhou Medical College of Soochow University Suzhou China.
Department of Neurology Minhang Hospital, Fudan University Shanghai China.
J Am Heart Assoc. 2024 Oct;13(19):e036527. doi: 10.1161/JAHA.124.036527. Epub 2024 Sep 18.
As a risk factor of cardiovascular diseases, homocysteine can be effectively lowered by folate. However, the associations of folate and homocysteine levels with the prognosis of ischemic stroke remained unclear.
A total of 3530 patients with ischemic stroke were included. Serum folate and homocysteine levels were measured at admission. The primary outcome was composite of death and major disability (modified Rankin Scale score≥3) at 3 months after stroke onset. Univariate and multivariate logistic regression models were used. The mediation effect of homocysteine was examined. During follow-up, 1056 participants developed the primary outcome. In the univariate model, participants in the highest quartile of folate had a 29% (95% CI, 0.58-0.87) decreased risk of primary outcome compared with those in the lowest quartile. After multivariate adjustment, the odds ratio associated with the highest quartile of folate was 0.58 (95% CI, 0.46-0.73) for primary outcome. In contrast, participants in the highest quartile of homocysteine had a 52% (95% CI, 1.24-1.98) increased risk of primary outcome compared with those in the lowest quartile. After multivariate adjustment, the odds ratio associated with highest quartile of homocysteine was 1.57 (95% CI, 1.24-1.98) for primary outcome. In addition, 25.5% of the observed associations between folate and primary outcome was mediated through homocysteine (=0.012).
High folate levels were associated with low risks of death and major disability among Chinese patients with ischemic stroke, and homocysteine partially mediated the observed potential beneficial role of folate.
同型半胱氨酸是心血管疾病的一个风险因素，可通过叶酸有效降低。然而，叶酸和同型半胱氨酸水平与缺血性脑卒中预后的关系仍不清楚。
共纳入 3530 例缺血性脑卒中患者。入院时检测血清叶酸和同型半胱氨酸水平。主要结局为脑卒中发病后 3 个月时死亡和主要残疾（改良 Rankin 量表评分≥3）的复合结局。采用单因素和多因素逻辑回归模型。检验了同型半胱氨酸的中介效应。随访期间，1056 名患者发生了主要结局。在单因素模型中，与最低四分位组相比，叶酸最高四分位组发生主要结局的风险降低了 29%（95%CI，0.58-0.87）。经多因素校正后，与叶酸最高四分位组相关的比值比为 0.58（95%CI，0.46-0.73）。相比之下，与最低四分位组相比，同型半胱氨酸最高四分位组发生主要结局的风险增加了 52%（95%CI，1.24-1.98）。经多因素校正后，与同型半胱氨酸最高四分位组相关的比值比为 1.57（95%CI，1.24-1.98）。此外，叶酸与主要结局之间观察到的关联有 25.5%是通过同型半胱氨酸介导的（=0.012）。
在中国缺血性脑卒中患者中，高叶酸水平与死亡和主要残疾的风险降低相关，同型半胱氨酸部分介导了叶酸的潜在有益作用。
