叶酸水平与心脑血管疾病终点事件的关联性及性别差异研究

A study on the association between folic acid levels and end-point events of cardio-cerebrovascular disease and its gender differences

目的探讨叶酸水平与心脑血管疾病(CVD)终点事件的关联性以及在不同性别间的差异。方法于2016年1月至2019年12月对采用多级分层随机抽样的方法选取的新疆维吾尔自治区额敏县≥15岁常驻人群共1791人进行随访调查。通过现场调查、电话随访、入户调查及调取当地县医院居民医疗记录等方式收集资料。通过Cox回归分析和DAG分析探讨叶酸水平与CVD终点事件的关联性。结果共有1687人完成了随访,143人发生了CVD终点事件,其中脑卒中和心梗占72.7%。对于总人群,与叶酸4.55~6.96 ng/ml组比较,<4.55 ng/ml组发生CVD终点事件的风险更高(HR=1.56,P=0.038)。对于男性,与叶酸>6.96 ng/ml组相比,<4.55 ng/ml组发生CVD终点事件的风险更高(HR=2.57,P=0.007)。对于女性,与叶酸4.55~6.96 ng/ml组相比,<4.55 ng/ml组和>6.96 ng/ml组发生CVD终点事件的风险均更高(HR=2.11,P=0.026;HR=1.84,P=0.039)。结论低叶酸水平与CVD终点事件发生风险增加相关,而对于女性,较高的叶酸水平也同样促进了CVD终点事件的发生。

Objective To explore the association between folic acid levels and end-point events of cardio-cerebrovascular disease(CVD)and its gender differences.Methods From January 2016 to December 2019,a total of 1791 residents aged≥15 years in Emin County,Xinjiang Uygur Autonomous Region were selected by multi-stage random sampling method for follow-up and investigation.The data were collected through on-site survey,telephone follow-up,household survey,and retrieval of medical records of residents from local county hospitals.Cox regression analysis and Directed Acyclic Graph(DAG)analysis were used to explore the correlation between folic acid levels and CVD end-point events.Results A total of 1687 respondents completed the follow-up,and 143 of them developed CVD end-point events,of which stroke and myocardial infarction accounted for 72.7%.For the total population,the risk of CVD end-point events in the folic acid<4.55 ng/ml group was higher than that in the folic acid 4.55-6.96 ng/ml group(HR=1.56,P=0.038).For the males,the risk of CVD end-point events in the folic acid<4.55 ng/ml group was higher than that in the folic acid>6.96 ng/ml group(HR=2.57,P=0.007).For the females,the risk of CVD end-point events in the folic acid<4.55 ng/ml group and the folic acid>6.96 ng/ml group was higher than that in the folic acid 4.55-6.96 ng/ml group(HR=2.11,P=0.026;HR=1.84,P=0.039).Conclusion Low level of folic acid is associated with an increased risk of CVD end-point events,and for females,higher level of folic acid also promotes the occurrence of CVD end-point events.