Association Between Serum Total Homocysteine And Arterial Stiffness In Adults:A Community-based Cross-sectional Study

Objective We aimed to test the relationship of tHcy with carotid-femoral pulse wave velocity(cfPWV)and examine the possible effect modifiers in adults.Methods From July 2016 to September 2016,an epidemiological survey on the H-type hypertension benefiting people project was carried out in twenty-one rural areas of Donghai County,Lianyungang,Jiangsu province,China.Through the epidemiological questionnaire to collect participants’gender,identity card number,past disease history,medication history,smoking,drinking,occupation and living conditions and other basic information,and the height,weight and blood pressure of the general physical examination.Homocysteine detection kit was used to detect serum total homocysteine level and carotid femoral artery pulse wave velocity was measured by portable automatic noninvasive arteriosclerosis instrument.Multivariable linear regression models and logistic regression models were performed to determine the association between tHcy,tHcy categories(<10,10-<15,and≥15μmol/L),or tHcy quartiles(<10.6,10.6-<12.8,12.8-<15.7,and≥15.7μmol/L)and cfPWV or arterial stiffness(cfPWV≥10 m/s).Results A total of 16 644 people were enrolled in this study.The mean age was(61.2±9.5)years,10532 women(63.3%),the mean tHcy was(13.9±9.5)μmol/L and the mean cfPWV was(9.4±2.3)m/s,The prevalence of arterial stiffness was 5295(31.8%).The low(<10μmol/L),medium(10-<15μmol/L)and high(≥15μmol/L)tHcy were19.5%,50.3%and 30.2%,respectively.Taking cfPWV and arterial stiffness as dependent variable,tHcy continuous variable(per 5μmol/L increment)was used as independent variable for multivariable linear regression and logistic regression analysis.After adjusted for sex,age,body mass index,systolic blood pressure,diastolic blood pressure,diabetes,hyperlipidemia,self-reportedcardiovasculardisease,antihypertensive drugs,smoking status,alcohol drinking,education,communities and stress showed that there was a positive association between tHcy and cfPWV levels(per5μmol/L tHcy increment:β=0.10;95%CI:0.08-0.13;P<0.001)and increased arterial stiffness(per 5μmol/L tHcy increment:OR=1.11;95%CI:1.07-1.14;P<0.001).When tHcy was used as the independent variable for the three categories(<10,10-<15,and≥15μmol/L),multivariable linear regression models and logistic regression analyzes adjusted for the above covariates showed that compared with participants with tHcy<10μmol/L,the significantly higher cfPWV levels were observed in those with tHcy≥15μmol/L(β=0.37;95%CI:0.28-0.47;P<0.001).Accordingly,the higher prevalence of increased arterial stiffness were found in those with tHcy 10-<15μmol/L(OR=1.18;95%CI:1.05-1.33;P=0.006)and tHcy≥15μmol/L(OR=1.50;95%CI:1.32-1.71;P<0.001)as compared to participants with tHcy<10μmol/L.Consistent with the above results,when with tHcy quartiles(<10.6,10.6-<12.8,12.8-<15.7,and≥15.7μmol/L)as independent variables,multivariable regression analysis showed similar results.Furthermore,the stronger positive association were found in participants who were older(≥60 years,P for interaction=0.008),had low BMI(<25 kg/m~2,P for interaction=0.026),high SBP levels[≥145 mmHg(median),P for interaction=0.048]or diabetes(P for interaction=0.045).Conclusions Serum tHcy concentrations were positively associated with cfPWV and the prevalence of increased arterial stiffness.the stronger positive association were found in participants who were older,had low BMI,high SBP levels or diabetes.