title: Combined Effect of Hyperhomocysteinemia and Hypertension on the Presence of Early Carotid Artery Atherosclerosis.
abstract: BACKGROUND
  To examine the individual effect of elevated homocysteine and its combined effect with hypertension on early carotid artery atherosclerosis (ECAS).
  
  
  METHODS
  We recruited 1257 subjects from a community-based population in Beijing, China, aged 55 years and older. The definition of hyperhomocysteinemia was referred to as the presence of homocysteine concentrations greater than 15 µmol/L. Carotid intima-media thickness (CIMT), plaque, the sum of plaque thickness (plaque score, PS), and plaque location in common carotid artery were established by ultrasonography. The presence of increased CIMT (≥1.0 mm) and plaque was defined as ECAS. Age, sex, smoking, alcohol drinking, physical activity, total cholesterol, glucose, estimated glomerular filtration rate, hypoglycemic therapy, and lipid-lowering therapy were adjusted by logistic regression analysis.
  
  
  RESULTS
  After adjustments for all potential confounders, the risks of presence of plaque, bilateral plaque, and high PS were significantly higher in the group with hyperhomocysteinemia as compared with reference group (the normal homocysteine and normotensive). The odds ratios (ORs) were 1.56 for presence of plaque (95% CI 1.05-2.33), 1.80 for bilateral plaque (95% CI 1.08-2.99), and 1.90 for high PS (95% CI 1.09-3.30), respectively. The group with both hyperhomocysteinemia and hypertension manifested the highest ORs of ECAS. The fully adjusted ORs were 1.67 for increased CIMT (95% CI 1.15-2.42), 2.48 for bilateral plaques (95% CI 1.54-3.99), and 2.69 for high PS (95% CI 1.61-4.47), correspondingly.
  
  
  CONCLUSIONS
  Elevated homocysteine had a mild-to-moderate independent effect on ECAS. Combined with hypertension, hyperhomocysteinemia might increase the strength of the above-mentioned effects.
authors.affiliation: Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Zhongying
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China. Electronic address: fangxh_2015@126.com.
authors.forename: Xianghua
authors.initials: X
authors.lastname: Fang
authors.affiliation: Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Hua
authors.affiliation: Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Beibei
authors.initials: B
authors.lastname: Liu
authors.affiliation: Department of Neurological Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Xunming
authors.initials: X
authors.lastname: Ji
authors.affiliation: Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tang
authors.affiliation: Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Chunxiu
authors.initials: C
authors.lastname: Wang
authors.affiliation: Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Shaochen
authors.initials: S
authors.lastname: Guan
authors.affiliation: Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Wu
authors.affiliation: Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Hongjun
authors.initials: H
authors.lastname: Liu
authors.affiliation: Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Gu
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D002681:China / Q000453:epidemiology; D042241:Early Diagnosis; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D015995:Prevalence; D065840:Protective Factors; D012307:Risk Factors; D012720:Severity of Illness Index; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D006710:Homocysteine
keywords: Homocysteine; atherosclerosis; carotid intima–media thickness; hypertension; plaque