Homocysteine for the risk of recurrent stroke in patients with stroke and hypertension

Objective To explore sex differences in risk factors for recurrent stroke in patients with H-type hypertension and stroke. Methods This was an observational study of 1407 patients with H-type hypertension and stroke based on medical record review from an electronic clinical information system. The median follow-up period was 4.9 years. The cumulative incidences of recurrent stroke were compared in different sex-group by using Kaplan-Meier survival analysis. Multivariable Cox analysis was used to evaluate sex differences in independent risk factors and their interactions on recurrent stroke. Results The recurrent stroke rates were slightly higher in men (20.4%) than women (18.3%), which were not significantly different (P>0.05). Kaplan-Meier survival analysis showed that a higher risk of recurrent stroke in the homocysteine (Hcy)≥19 μmol/L group (vs Hcy<19 μmol/L group) of men and diabetes mellitus (DM) group (vs non-DM group), atrial fibrillation (AF) group (vs non-AF group) or ≥60 years group (vs <60 years group) of women (P<0.05). Fasting plasma glucose (FPG) ≥7.0 mmol/L group (vs FPG<7.0 mmol/L group) had an increased risk of recurrent stroke in both women and men (P<0.05). Multivariable Cox proportional hazards model showed that DM and elevated Hcy levels were independent risk factors for recurrent stroke in men, and older age, AF and elevated FPG levels in women (P<0.05). The DM-sex interaction and AF-sex interaction were confirmed, which suggested a higher risk of recurrent stroke in women with DM or AF compared with men (P<0.05). The interactions between DM and other risk factors on recurrent stroke were statistically significant: body mass index and Hcy in men, and systolic blood pressure, diastolic blood pressure and Hcy in women (P<0.05). Conclusion It is recommended that the effectiveness of risk factors alone and the interactions between them for prevention of recurrent stroke in patients with H-type hypertension and stroke should be fully evaluated. There is a need for a stroke risk score for each sex. Multiple cardiovascular risk factors should be controlled simultaneously to better reduce the risk of recurrent stroke. Key words: Hypertension; Stroke; Homocysteine; Recurrence