Analysis On The Correlation Between Homocysteine And Cardiovascular Events Of Beijing Community Population

Background:Cardiovascular disease is the main killer that threatens human life and health all the time. In recent years, with the improvement of people’s living standard and social aging process, the occurrence of cardiovascular disease increases year by year. Therefore, people take early diagnosis and treatment of atherosclerotic cardiovascular disease more seriously, in order to reduce mortality and disability rate and improve the prognosis of patients. Arterial stiffness has been increasingly recognized as a strong predictor of cardiovascular disease and atherosclerotic disease, and carotid-femoral PWV is the ’gold standard’ for arterial stiffness.Elevated plasma homocysteine has been considered as another predictor risk factor for cardiovascular diseases, as well as subsequent mortality. With the in-depth study of the pathogenesis of cardiovascular disease, assessment and intervention of the risk factors in cardiovascular disease is quite important. Studies have shown that elevated plasma homocysteine can lead to atherosclerosis, has certain prediction effect of cardiovascular disease.Therefore, the research on the relationship between the level of plasma homocysteine and cardiovascular events has become a hot topic.Objective:Previous studies have shown the positive correlation which is between the level of homocysteine (Hcy) and atherosclerosis is an independent risk factor in cardiovascular events. The study on the relationship between Hey and cardiovascular events is cross-sectional one, and the predictor of cardiovascular events is rarely reported, especially in community population. The purpose of this study is to determine the relationship in community population between the level of Hcy with arterial stiffness and cardiovascular events, and to explore the function of Hey level which can predict arterial stiffness and cardiovascular events.Methods:2007 September to 2009 January, there are two community people of Beijing who had physical examination and established a complete database of 1680 cases related to cardiovascular disease risk factors.In 2003 February to September,1499 subjects completed the follow-up (follow-up rate-89.2%). Of these 52 were excluded because of death, leaving 1447 participants available for analysis. We observe the relationship between the level of plasma Hcy and arterial stiffness as well as the relationship between the change in Hcy and PWV. In this 1499 cases, we observe the relationship between the level of plasma Hcy and all-cause mortality, non fatal myocardial infarction and non fatal stroke. The data of the level of Hcy and arterial stiffness is analyzed by Logistic regression. The data of the level of Hcy and cardiovascular events is analyzed by Cox statistical regression.Results:In the 1499 cases of community participants (average age 61 years, male 630 cases, female 869 cases,average follow-up time 4.8 years),157 participants experienced new-onset major cardiovascular events, there were 52 deaths, including 24 cardiovascular disease deaths.39 subjects had myocardial infarction, and 63 strokes. ① In a multivariable linear regression analysis, Hcy was independently associated with carotid-femoral PWV (P=0.817, P=0.015); Logistic regression analysis showed that after adjustment for other factors, follow-up carotid-femoral PWV was significantly associated with the baseline Quartile 3 level of Hcy (OR=1.833,95%CI:1.069-3.142, P=0.028), and Quartile 4 (OR=2.304,95%CI:1.261-4.209, P=0.007); In the stepwise logistic regression, there was an association between PWV δ and baseline Quartile 2 Hcy level (OR=1.656,95% CI:1.011-2.711, P=0.045), Quartile 3(OR=1.757,95%CI: 1.097-2.813, p=0.019) and Quartile4 (OR= 1.756,95%CI:1.058-2.915, P=0.029). ② Cox regression analysis showed that after adjustment for traditional risk factors and drug treatment, Hcy was an independent predictor of MACE (HR=1.022,95% CI:1.002-1.048, P=0.035), which is associated with the cardiovascular death (HR=1.271, 95% CI:1.019-1.587, P=0.034), and has related to all-cause mortality (HR=1.061,.95% CI:1.008-1.116, P=0.022). The result is consistent in the older population.Conclusion:In the community, Hcy is the independent predictor of central arterial stiffness (cfPWV) and the plasma Hcy levels showed a significant association with increases in carotid-femoral PWV(cfPWV5). The research is available for evaluating the level of atherosclerosis as a new predict incident and theroetical evidence. Hcy is an independent predictor of MACE, and is related to cardiovascular death. It is suggested that the extraction of plasma Hcy is of great significance for the prediction of the general population in the community of cardiovascular events.At the same time for clinical prediction, diagnosis, the occurrence of cardiovascular events and severity provides new thought and effective reference indicator.