title: Homocysteine, Ischemic Stroke, and Coronary Heart Disease in Hypertensive Patients: A Population-Based, Prospective Cohort Study.
abstract: OBJECTIVE
  Total homocysteine level (tHcy) is a risk factor of ischemic stroke (IS) and coronary heart disease. However, the results are conflicting and mainly focused on healthy individuals in developed countries.
  
  
  METHODS
  A prospective, population-based cohort study was conducted among 5935 participants from 60 communities in the city of Shenzhen, China. A Cox regression analysis was applied to evaluate the contribution of tHcy to the risk of IS and coronary heart disease. The effect of folic acid supplementation on tHcy levels was also evaluated among 501 patients with essential hypertension, who received an average of 2.5 years of folic acid supplementation.
  
  
  RESULTS
  After adjustment for confounding factors, the hazard ratios (95% confidence intervals) of IS caused by hyperhomocysteinemia were 2.18 (1.65-2.89), 2.40 (1.56-3.67), and 2.73 (1.83-4.08) in the total, male, and female participants, respectively. Compared with normal levels of tHcy (<15 μmol/L), the hazard ratios (95% confidence intervals) for IS in the highest tHcy category (≥30 μmol/L) were 4.96 (3.03-8.12), 6.11 (3.44-10.85), and 1.84 (0.52-6.46) in the total, males, and females participants, respectively. However, we did not observe a significant relationship between tHcy and the risk of coronary heart disease. The 2.5 years of folic acid supplementation reduced tHcy levels by 6.7 μmol/L (27.92%) in patients with essential hypertension.
  
  
  CONCLUSIONS
  Hyperhomocysteinemia in Chinese hypertensive patients is significantly associated with IS risk but not coronary heart disease susceptibility, and folic acid supplementation can efficiently reduce tHcy levels.
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.).
authors.forename: Liyuan
authors.initials: L
authors.lastname: Han
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.). wuqunhong@163.com zhaojinshun@nbu.edu.cn duanshiwei@nbu.edu.cn.
authors.forename: Qunhong
authors.initials: Q
authors.lastname: Wu
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.).
authors.forename: Changyi
authors.initials: C
authors.lastname: Wang
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.).
authors.forename: Yanhua
authors.initials: Y
authors.lastname: Hao
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.). wuqunhong@163.com zhaojinshun@nbu.edu.cn duanshiwei@nbu.edu.cn.
authors.forename: Jinshun
authors.initials: J
authors.lastname: Zhao
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.).
authors.forename: Lina
authors.initials: L
authors.lastname: Zhang
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.).
authors.forename: Rui
authors.initials: R
authors.lastname: Fan
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.).
authors.forename: Yanfen
authors.initials: Y
authors.lastname: Liu
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.).
authors.forename: Runhua
authors.initials: R
authors.lastname: Li
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.).
authors.forename: Zhongwei
authors.initials: Z
authors.lastname: Chen
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.).
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.).
authors.forename: Sihan
authors.initials: S
authors.lastname: Chen
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.).
authors.forename: Jianping
authors.initials: J
authors.lastname: Ma
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.).
authors.forename: Shengyuan
authors.initials: S
authors.lastname: Liu
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.).
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Peng
authors.affiliation: From the Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China (L.H., J.Z., L.Z., R.F., Y.L., R.L., S.D.); Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China (Q.W., Y.H.); Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (C.W., Z.C., T.Z., S.C., J.M., S.L., X.P.). wuqunhong@163.com zhaojinshun@nbu.edu.cn duanshiwei@nbu.edu.cn.
authors.forename: Shiwei
authors.initials: S
authors.lastname: Duan
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D006710:Homocysteine
keywords: coronary heart disease; homocysteine; hypertension; ischemia; stroke