To Investigate The Association Of Plasma Homocysteine With Ideal Cardiovascular Health And The Risk Of ASCVD In People Without ASCVD

Objective:(1)To assess the overall ideal cardiovascular health(ICVH)in people with nonatherosclerotic cardiovascular disease(ASCVD).(2)The differences of ICVH levels between males and females were analyzed.(3)To explore the influencing factors of hyperhomocysteinemia(HHcy).(4)To investigate the relationship between plasma homocysteine(Hcy)level and the risk of ASCVD in non-ASCVD population.Methods: The study subjects were adults aged 20-65 years who underwent physical examination and completed the ideal cardiovascular health behavior questionnaire in the Physical Examination Center of the Affiliated Hospital of Inner Mongolia Medical University from December 2021 to September 2022 and met the inclusion criteria.The age and gender of all subjects were recorded,and their height,weight and waist circumference were measured.Body mass index(BMI)was calculated.Hcy,total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),fasting blood glucose(FBG),systolic blood pressure(SBP),diastolic blood pressure(DBP),left arm ankle artery pulse wave velocity(L-ba PWV),right arm ankle artery pulse wave velocity were measured(R-ba PWV),left arm ankle blood pressure index(L-ABI),right arm ankle blood pressure index(R-ABI).The 10-year and lifetime risk of ASCVD were calculated using the China-PAR model.According to the diagnostic criteria of HHcy,the subjects were divided into normal group(Hcy<15μmol/L)and HHcy group(Hcy≥15μmol/L).According to the 10-year risk stratification criteria for ASCVD,the subjects were divided into high-risk group,intermediate-risk group and low-risk group.The participants were divided into low-risk group and high-risk group according to the lifetime risk stratification criteria for ASCVD.SPSS25.0software and R language were used for data analysis and drawing.Results:(1)A total of 364 subjects were included in this study,including 202 males(55.5%)and 162 females(44.5%).Among all the subjects,251(69.0%),91(25.0%),139(38.2%),221(60.7%),144(39.6%),242(66.5%),and 310 achieved ideal levels of smoking,diet,exercise,BMI,blood pressure,TC,FBG,and ICVH,respectively 85.2%,207(56.9%),respectively.(2)There were significant differences in overall ICVH and smoking,diet,blood pressure,FBG and BMI between males and females(P<0.05).(3)Among the 364 subjects,175 were in the HHcy group,including 128 males(35.2%)and 47 females(12.91%),and 189 were in the normal group,including 74 males(20.33%)and 115 females(31.59%).There was a statistically significant difference in gender between the two groups(P<0.05).The mean age,BMI,waist circumference,SBP,DBP,LDL-C,L-ba PWV,R-ba PWV,10-year risk of ASCVD,lifetime risk of ASCVD,prevalence of hypertension,smoking(non-ideal)rate,diet(non-ideal)rate in HHcy group were higher than those in normal group,while ICVH score was lower than that in normal group.The difference was statistically significant(P<0.05).(4)HHcy was positively correlated with age,gender(male),BMI,waist circumference,SBP,DBP,LDL-C,L-ba PWV,R-ba PWV,and hypertension,and negatively correlated with ICVH score,smoking(ideal),and diet(ideal)(P<0.05).(5)Multivariate Logistic regression analysis showed that ideal diet[OR(95%CI):0.29(0.16-0.52),P<0.001] was a protective factor for HHcy.Gender(male)[OR(95% CI): 2.36(1.24-4.48),P = 0.009 < 0.05] and LDL-C [OR(95% CI): 1.48(1.09-2.01),P = 0.013< 0.05] for HHcy risk factors.(6)The predictive effect of LDL-C on HHcy: the area under the ROC curve was 0.598(95%CI:0.540-0.655,P=0.001),the best cut-off value was 2.815mmol/L,the sensitivity was 0.669,and the specificity was 0.497.(7)HHcy was negatively correlated with fish(ideal),fruits and vegetables(ideal),and red meat(ideal)in the ideal dietary structure(P<0.05),and had no significant correlation with soy products,dairy products,and tea(P>0.05).(8)Multivariate Logistic regression showed that increasing the intake of fresh vegetables and fruits and reducing the intake of red meat and over-processed or preserved meat were protective factors for HHcy(P<0.05).(9)A total of 364 subjects were included in this study.Among them,55 subjects were in the high risk group,90 subjects in the intermediate risk group and 219 subjects in the low risk group for 10-year ASCVD.The Hcy level in the high risk group was higher than that in the medium and low risk groups,and the Hcy level in the intermediate risk group was higher than that in the low risk group.The lifetime risk of ASCVD was 288 in the low-risk group and 76 in the high-risk group.The Hcy level in the high-risk group was higher than that in the low-risk group,and the difference was statistically significant(P<0.05).(10)The level of Hcy was positively correlated with the 10-year and lifetime risk of ASCVD(P<0.05).(11)Logistic regression analysis showed that after adjusting for age,gender,smoking status,TC,BMI,HDL-C,waist circumference,hypertension,family history,and diabetes,Hcy was still a risk factor for the 10-year risk of ASCVD(≥5%),and the difference was statistically significant(P<0.05).However,after adjusting for a series of confounding factors,there was no significant effect of Hcy on the lifetime risk of ASCVD(≥32.8%,P>0.05).(12)After adjusting for confounding factors,there was a linear dose-response relationship between Hcy and 10-year ASCVD risk(≥5%)in restricted cubic spline(RCS)curve(P=0.392>0.05).Hcy = 30.54 mu mol/L [OR(95% CI): 1.84(1.00-3.37),(P < 0.05),and Hcy >30.54 mu mol/L,OR(95% CI)were greater than 1(P < 0.05).Conclusions:(1)The performance of ICVH in non-ASCVD population was relatively poor in diet,exercise and blood pressure.(2)The overall ICVH level and the ideal status of smoking,diet,blood pressure,FBG and BMI in women were better than those in men.(3)HHcy was positively correlated with age,male,BMI,waist circumference,SBP,DBP,LDL-C,L-ba PWV,R-ba PWV,and hypertension,and negatively correlated with ICVH score,non-smoking,and ideal diet.(4)Male and LDL-C are the risk factors of HHcy,and LDL-C has a certain predictive effect on the diagnosis of HHcy.(5)An ideal dietary structure is a protective factor for HHcy.Increasing the intake of fresh vegetables and fruits and reducing the intake of red meat and over-processed or pickled meat have a positive effect on the prevention of HHcy.(6)The level of Hcy was positively correlated with the 10-year and lifetime risk of ASCVD.(7)The 10-year risk of ASCVD(≥5%)was significantly increased when Hcy>30.54μmol/L.