Clinical Characteristics Of Hyperhomocysteinemia With Different Diagnostic Cut-off Points And Its Relationship With Hypertension

Objective:To investigate plasma homocysteine?Hcy?in the elderly??65 years?,and the clinical characteristics of different diagnostic cut-off points of hyperhomocysteinemia?H Hcy?and its relationship with hypertension,decreased estimated glomerular filtration rate?eGFR?and ECG-based detection left ventricular hypertrophy?ECG-LVH?.Methods:We selected elderly people aged 65 years or older who underwent health examination in a Community Health Center?Pudong District,Shanghai?in 2015.Venous blood samples were drawn after overnight fasting for themeasurement of plasma Hcy and glucose,and serum blood lipids and creatinine.We administered a standardized questionnaire to collectinformation on medical history,lifestyle and use of medications.We used 10,15 and 20?mol/L ofHcy as cut-off points for diagnose of HHcy,respectively.We used Chinese modified MDRD equation to calculate eGFR,and defined eGFR<60ml/min1.73m2as decreased eGFR.ECG-LVH was diagnosed as a Cornell voltage of Ra_VL+Sv₃>2.8mV?if male?or 2.0 mV?if female?.Result:?1?Determinants and clinical characteristicsof HHcy based on different diagnostic cut-off points.5976 elderlysubjects was included in the final analysis.The prevalence ofHcy?10,15,20?mol/L?HHcy?were 85.0%,41.6%and 18.7%respectively in total population,were 91.5%,51.5%and 24.8%respectively in males,and were 79.7%,33.8%and 13.8%respectively in females.Compared with subjects with normal,HHcy patientsbased on above three different diagnostic cut-off points tended to be older?P<0.001?,had higher proportion of male and smokers,and had faster heart rate?P<0.05?,higher serum creatinine?P<0.001?,lower glycosylated hemoglobin?P<0.001?and lower high-density lipoprotein?P<0.001?.In multivariate regression analysis,age,smoking,serum creatinine and glycosylated hemoglobin were determinants of HHcypatientsbased on three different diagnostic criteria.?2?Relationship between HHcy and hypertension,glomerular filtration rate,and left ventricular hypertrophy.The prevalence of hypertension was 64.8%in males and 67.7%in females.Hcy level in hypertensive patients was higher than that in normotensive patients?14.7 vs.14.2?mol/L,P=0.005?.However,after adjusted with gender,age,BMI,heart rate,glycosylated hemoglobin,and high and low density lipoprotein,there was no significant difference between hypertensive patients and normotensive patients?P=0.06?.The level of eGFR was significantly lower?P<0.001?in patients of HHcy?defined by three different diagnostic criteria?than those of normotensive subjects.In multivariate regression analysis,Hcy was showed closely correlated with the decrease of eGFR?P<0.001?.In unadjusted analysis,Hcy was associated with LVH?P=0.03?.However,Hcy was not significantly associated with ECG-LVH?P=0.07?after adjustment for serum creatinine.Conclusion:HHcy,no matter which diagnostic criteria was used,was significantly associated with age,smoking,serum creatinine and HbA1c,and especially significantly associated with renal function.However,no independent association was found between HHcy and hypertension risk or ECG-LVH based on any of three different diagnostic criteria.