Longitudinal association between fasting blood glucose concentrations and first stroke in hypertensive adults in China: effect of folic acid intervention
Background: Diabetes is a known risk factor for stroke, but data on its prospective association with first stroke are limited. Folic acid supplementation has been shown to protect against first stroke, but its role in preventing first stroke in diabetes is unknown. Objectives: This post hoc analysis of the China Stroke Primary Prevention Trial tested the hypotheses that the fasting blood glucose (FBG) concentration is positively associated with first stroke risk and that folic acid treatment can reduce stroke risk associated with elevated fasting glucose concentrations. Design: This analysis included 20,327 hypertensive adults without a history of stroke or myocardial infarction, who were randomly assigned to a double-blind daily treatment with 10 mg enalapril and 0.8 mg folic acid (n = 10,160) or 10 mg enalapril alone (n = 10,167). Kaplan-Meier survival analysis and Cox proportionate hazard models were used to test the hypotheses with adjustment for pertinent covariables. Results: During a median treatment duration of 4.5 y, 616 participants developed a first stroke (497 ischemic strokes). A high FBG concentration (>= 7.0 mmol/L) or diabetes, compared with a low FBG concentration (< 5.0 mmol/L), was associated with an increased risk of first stroke (6.0% compared with 2.6%, respectively; HR: 1.9; 95% CI: 1.3, 2.8; P < 0.001). Folic acid treatment reduced the risk of stroke across a wide range of FBG concentrations >= 5.0 mmol/L, but risk reduction was greatest in subjects with FBG concentrations >= 7.0 mmol/L or with diabetes (HR: 0.66; 95% CI: 0.46, 0.97; P < 0.05). There was a significant interactive effect of FBG and folic acid treatment on first stroke (P = 0.01). Conclusions: In Chinese hypertensive adults, an FBG concentration >= 7.0 mmol/L or diabetes is associated with an increased risk of first stroke; this increased risk is reduced by 34% with folic acid treatment. These findings warrant additional investigation.
基金:
National Science and Technology Major Projects Specialized for "Precision Medicine Research" [2016YFC0903100]; Projects of National Natural Science Foundation of ChinaNational Natural Science Foundation of China [81473052, 81402735]; Science, Technology and Innovation Committee of Shenzhen [JCYL20130401162636527]; Department of Development and Reform, Shenzhen Municipal Government [SFG 20201744]; Special Project on the Integration of Industry, Education and Research of Guangdong Province [2011A091000031]; Science and Technology Planning Project of Guangdong Province, China [2014B090904040]
第一作者机构:[1]Peking Univ, Hosp 1, Dept Cardiol, Beijing, Peoples R China;
通讯作者:
通讯机构:[1]Peking Univ, Hosp 1, Dept Cardiol, Beijing, Peoples R China;
推荐引用方式(GB/T 7714):
Xu Richard B.,Kong Xiangyi,Xu Benjamin P.,et al.Longitudinal association between fasting blood glucose concentrations and first stroke in hypertensive adults in China: effect of folic acid intervention[J].AMERICAN JOURNAL OF CLINICAL NUTRITION.2017,105(3):564-570.doi:10.3945/ajcn.116.145656.
APA:
Xu, Richard B.,Kong, Xiangyi,Xu, Benjamin P.,Song, Yun,Ji, Meng...&Li, Jianping.(2017).Longitudinal association between fasting blood glucose concentrations and first stroke in hypertensive adults in China: effect of folic acid intervention.AMERICAN JOURNAL OF CLINICAL NUTRITION,105,(3)
MLA:
Xu, Richard B.,et al."Longitudinal association between fasting blood glucose concentrations and first stroke in hypertensive adults in China: effect of folic acid intervention".AMERICAN JOURNAL OF CLINICAL NUTRITION 105..3(2017):564-570