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Longitudinal association between fasting blood glucose concentrations and first stroke in hypertensive adults in China: effect of folic acid intervention

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机构: [1]Peking Univ, Hosp 1, Dept Cardiol, Beijing, Peoples R China; [2]Southern Med Univ, Nanfang Hosp, Natl Clin Res Study Ctr Kidney Dis, State Key Lab Organ Failure Res,Renal Div, Guangzhou, Guangdong, Peoples R China; [3]Fudan Univ, Zhongshan Hosp, Dept Cardiol, Shanghai, Peoples R China; [4]Nanchang Univ, Affiliated Hosp 2, Dept Cardiol, Nanchang, Jiangxi, Peoples R China; [5]Capital Med Univ, Beijing Anzhen Hosp, Dept Cardiol, Beijing, Peoples R China; [6]Anhui Med Univ, Sch Hlth Adm, Hefei, Peoples R China; [7]Fudan Univ, Huashan Hosp, Dept Neurol, Shanghai, Peoples R China; [8]Chinese Peoples Liberat Army Gen Hosp, Dept Cardiol, Beijing, Peoples R China; [9]Chinese Peoples Liberat Army Gen Hosp, Dept Geriatr Cardiol, Beijing, Peoples R China; [10]Cent S Univ, Xiangya Hosp, Dept Cardiol, Changsha, Hunan, Peoples R China; [11]Peking Univ, Peoples Hosp, Dept Cardiol, Beijing, Peoples R China; [12]Peking Univ, Peoples Hosp, Dept Endocrinol & Metab, Beijing, Peoples R China; [13]Fourth Mil Med Univ, Tangdu Hosp, Dept Cardiol, Xian, Peoples R China
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关键词: Chinese folic acid hyperglycemia hypertension stroke

摘要:
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.

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出版当年[2016]版:
大类 | 1 区 医学
小类 | 1 区 营养学
最新[2023]版:
大类 | 1 区 医学
小类 | 1 区 营养学
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出版当年[2015]版:
Q1 NUTRITION & DIETETICS
最新[2023]版:
Q1 NUTRITION & DIETETICS

影响因子: 最新[2023版] 最新五年平均 出版当年[2015版] 出版当年五年平均 出版前一年[2014版] 出版后一年[2016版]

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第一作者机构: [1]Peking Univ, Hosp 1, Dept Cardiol, Beijing, Peoples R China;
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通讯机构: [1]Peking Univ, Hosp 1, Dept Cardiol, Beijing, Peoples R China;
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