Comparison of homocysteinemia and MTHFR 677CT polymorphism with Framingham Coronary Heart Risk Score

Association of serum VLDL level with hyperhomocysteinemia in hypertensive patients: A cross-sectional study

BACKGROUND

Increasing evidence suggests that hyperhomocysteinemia (HHcy) and hyperlipidemia have been recognized as two independent risks for cardiovascular disease. However, the association between hyperlipidemia and HHcy in hypertensive patients has not been systemically elucidated. The aim of this study was to investigate the relation between very low-density lipoprotein (VLDL) and HHcy in hypertensive patients.

METHODS

From July 2013 to March 2014, a large cross-sectional study was performed using 4012 participants from urban and rural communities in Hunan province, China. Participants underwent accurate assessment of lipid profiles, homocysteine (Hcy), anthropometric, blood pressure, and other biochemical indicators.

RESULTS

Among 1257 participants with hypertension, 626 (49.80%) were men and 631 (50.20%) were women. In total, 1081 (86.00%) of the participants were found to have HHcy, of which 559 (44.47%) were men and 522 (41.53%) were women. In the univariate analysis, the OR for patients with hypertension associated with hyperhomocysteinemia was significantly enhanced as the quartiles of the Log VLDL were increased. OR for quartile 4 was significantly higher than that for quartile 1 (OR = 3.7, 95% CI: 2.6-5.1; P< .001). Additional adjustment for the confounding variables did not reduce the ORs for the association between the Log VLDL and hypertension associated with hyperhomocysteinemia (OR = 3.8, 95% CI: 2.7-5.5; P< .001; OR = 4.3, 95% CI: 1.6-11.8; P= .004, respectively). We also conducted analyses with Log VLDL as a continuous variable. Each unit increase in the Log VLDL was associated with the 1.3-fold increased risk of hypertension associated with hyperhomocysteinemia (95% CI: 1.9-2.9; P< .001). Adjusting for Cr, TG, TC, and HDL did not affect the relationship.

CONCLUSIONS

Our data indicate that the Log VLDL concentrations appear to be an independent contributor to hypertension associated with hyperhomocysteinemia, even after adjusting for age and other covariables. The utility of the Log VLDL as a diagnostic, prognostic, and therapeutic indicator for the disease warrants further investigation.

ABBREVIATIONS

HHcy: hyperhomocysteinemia; Hcy: homocysteine; VLDL: very low-density lipoprotein; CVD: cardiovascular disease; SBP: systolic blood pressure; DBP: diastolic blood pressure; BMI: body mass index; ALT: alanine aminotransferase; Cr: creatinine; UA: uric acid; TG: triglycerides; TC: total cholesterol; HDL: high-density lipoprotein; LDL: low-density lipoprotein; FBG: fasting blood glucose; CRP: C-reactive protein; MTHFR: methylene tetrahydrofolate reductase; NO: nitric oxide; HDL-C: high-density lipoprotein cholesterol.

Life-threatening course in coronavirus disease 2019 (COVID-19): Is there a link to methylenetetrahydrofolic acid reductase (MTHFR) polymorphism and hyperhomocysteinemia?

As the current COVID-19 pandemic develops and epidemiological data reveals differences in geographical spread as well as risk factors for developing a severe course of illness, hypotheses regarding possible underlying mechanisms need to be developed and tested. In our hypothesis, we explore the rational for a role of MTHFR polymorphism C677T as a possible explanation for differences in geographical and gender distribution in disease severity. We also discuss the role of the resulting hyper-homocysteinemia, its interaction with the C677T polymorphism and its influence on immune state as well as risk factors for severe disease. Finally, we consider possible dietary ways to influence the underlying pathomechanisms prophylactically and supportively.

Association of High Homocysteine Levels With the Risk Stratification in Hypertensive Patients at Risk of Stroke

PURPOSE

We aimed to investigate the association between stroke morbidity and different stratifications of classic risk factors, such as increasing age, body mass index (BMI), blood lipids, and blood glucose, in hypertensive patients with high homocysteine levels.

METHODS

A cross-sectional study of 2258 patients with primary hypertension were enrolled in this study, including 871 stroke cases (62.89%) in 1385 hypertensive patients without hyperhomocysteinemia (HHcy) and 647 (74.11%) stroke cases in 873 hypertensive patients with HHcy. Basic information of patients were collected, including age, sex, height, weight, smoking, alcohol consumption, and disease history. Blood chemical assays were performed to determine the levels of glucose, triglycerides, high-density lipoprotein cholesterol (HDL-C), total cholesterol, and homocysteine. Subsequently, comparison of stroke morbidity between the 2 groups was performed after the stratification of risk factors. Moreover, the correlation between the stroke morbidity and the risk factors was analyzed using a trend test in patients with H-type hypertension. Univariate and multivariate logistic regression analyses were used to evaluate the association between baseline factors and prevalence of stroke in H-type hypertensive patients.

FINDINGS

After the stratification of risk factors, a statistical difference was noted in age (range, 45-74 yrs), glucose ranges (<6.1 and ≥7.0 mmol/L), BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), non-HDL-C, and triglyceride level of <200 mg/dL (P<0.05) in the H-type hypertension group compared with those in non-H-type hypertension group. Gradual elevation of stroke morbidity was identified with the increase of fasting glucose, SBP, and DBP. In multivariate logistic regression analysis, only higher SBP, DBP, fasting glucose level, homocysteine, and history of diabetes mellitus were the independent predictors for the stroke morbidity.

IMPLICATIONS

Comprehensive evaluation and strict management of multiple risk factors have become increasingly important in the alleviation of stroke morbidity for H-type hypertensive patients because these patients were more sensitive to the classic risk factors.

Potential Risk Factors Associated With Vascular Diseases in Patients Receiving Treatment for Hypertension

Background

Currently, the hypertension (HTN) patients undergo appropriate medical treatment, and traditional risk factors are highly controlled. Therefore, potential risk factors of atherosclerotic vascular diseases (AVD) and venous thromboembolisms (VTE) in HTN should be reconsidered. We investigated thrombophilic genetic mutations and existing biomarkers for AVD or VTE in HTN patients receiving treatment.

Methods

A total of 183 patients were enrolled: AVD with HTN (group A, n=45), VTE with HTN (group B, n=62), and HTN patients without any vascular diseases (group C, n=76). The lipid profile, homocysteine (Hcy) levels, D-dimers, fibrinogen, antithrombin, lupus anticoagulant, and anti-cardiolipin antibody (aCL) were evaluated. Prothrombin G20210A, Factor V G1691A, and methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C were analyzed.

Results

All patients revealed wild type prothrombin G20210A and Factor V G1691A polymorphisms. The frequency of MTHFR polymorphisms was 677CT (n=84, 45.9%); 677TT (n=46, 25.1%); 1298AC (n=46, 25.1%); and 1298CC (n=2, 1.1%). The MTHFR 677TT genotype tended to increase the odds ratio (OR) to AVD events in HTN patients (OR 2.648, confidence interval 0.982-7.143, P=0.05). The group A demonstrated significantly higher Hcy levels (P=0.009), fibrinogen (P=0.004), and platelet counts (P=0.04) than group C. Group B had significantly higher levels of D-dimers (P=0.0001), platelet count (P=0.0002), and aCL (P=0.02) frequency than group C.

Conclusions

The MTHFR 677TT genotype and Hcy level could be potential risk factors associated with development of AVD in HTN patients receiving treatment. D-dimer and aCL might be useful to estimate the occurrence of VTE in them.