Study Of Relationship Between Folate Level And End-point Events Of Cardio-cerebro Vascular Disease

Objective: To understand the relationship between folate level and end-point events of cardio-cerebro vascular disease(CVD).Methods: From January to December 2014,a total of 1,926 subjects meeting the inclusion and exclusion criteria were collected,by multi-stage random sampling method,in Emin,Tacheng,Xinjiang,and then questionnaire survey,human index measurement and collection of blood samples were conducted.From January 2016 to December 2019 we conducted four follow up visits,and the end point events of CVD was confirmed by the face to face field questionnaire,among them,the patients who had visited a district or county level hospital or expressed relevant examination data to clearly support the diagnosis were regarded as the occurrence of the end event.For those who failed to be confirmed on the spot,questionnaire information and survival situation was obtained by checking the local county hospital diagnosis and treatment records and Social Security Bureau and Public Security Bureau registration information,household survey and telephone follow-up.The folate level tertiles were divided from low to high,with the order of T1-T3,and the minimum sufficient necessary adjustment set obtained by directed acyclic graph(DAG),and was reference to the COX regression analysis,to investigate the relationship between folate level and end-point events of CVD.Further,a trend chart was drawn by restricted cubic spline(RCS).Finally,we calculated the adjusted population attributable risk(PAR)to determine that controlling folic acid in a ideal range can reduce the percentage of end-point events of CVD percentage in Emin County,Tancheng,Xinjiang.Results: A total of 1,687 people(727 men and 960 women)with 4.75 years of Median follow-up time and 5.8% loss follow.A total of 143 outcome events were recorded.(1)Patients of group T1 had higher homocysteine levels than those of group T2 and T3(15.42±9.65 vs 13.23±5.60 vs11.30±4.15)and more tend to be male(48.3% vs 44.3% vs 36.6%)and the Kazakhs(53.1% vs33.0% vs 13.1%)with a P value <0.05.(2)Multivariate Cox regression after adjusting for gender,age,and BMI showed that T1 had 1.56 timed(P<0.05)and T3 had 1.05 times(P>0.05)higher risk of CVD morbidity and mortality than T2.Analysis by sex showed that T1 group was a risk factor for CVD morbidity and mortality in both men and women(HR=1.34,95%CI 0.77-2.34 and HR=2.11,95%CI 1.09-4.07),in addition,T3 group,in women,is a hazard factor of CVD morbidity and mortality too(HR=1.84,95%CI 1.03-3.29).(3)Adjusted RCS revealed a U-shaped relationship between folate and the risk of CVD morbidity and mortality,and the folate level at7.5-9.5ng/m L of male and 4-7.5ng/m L of female has the lowest risk of CVD morbidity and mortality.(4)Adjusted PAR showed male and female with a folate level of 7.5-9.5ng/m L and4-7.5ng/m L could reduce the risk of CVD morbidity and mortality by 6.12% and 3.48%separately.Conclusion:(1)The U-shaped relationship between folate and CVD morbidity and mortality was found.(2)keeping folate in a medium level reduced CVD risk of by 6.12% and 3.48%,respectively,in men and women in Emin,Tacheng,Xinjiang.