Previous studies have shown that low platelet count combined with high plasma total homocysteine(tHcy)increased stroke risk and can be lowered by 73% with folic acid.However,the combined role of other platelet activat...Previous studies have shown that low platelet count combined with high plasma total homocysteine(tHcy)increased stroke risk and can be lowered by 73% with folic acid.However,the combined role of other platelet activation parameters and the methylenetetrahydrofolate reductase(MTHFR)C677T genotypes on stroke risk and folic acid treatment benefit remain to be examined.This study aimed to investigate if platelet activation parameters and MTHFR genotypes jointly impact folic acid treatment efficacy in first stroke prevention.Data were derived from the China Stroke Primary Prevention Trial.This study includes a total of 11,185 adult hypertensive patients with relevant platelet activation parameters and MTHFR genotype data.When simultaneously considering both platelet activation parameters(plateletcrit,platelet count,mean platelet volume,platelet distribution width)and MTHFR genotypes,patients with both low plateletcrit(Q1)and the TT genotype had the highest stroke incidence rate(5.6%)in the enalapril group.This subgroup significantly benefited from folic acid treatment,with a 66% reduction in first stroke(HR:0.34;95%CI:0.14-0.82;p=0.016).Consistently,the subgroup with low plateletcrit(Q1)and the CC/CT genotype also benefited from folic acid treatment(HR:0.40;95%CI:0.23-0.70;p=0.001).In Chinese hypertensive adults,low plateletcrit can identify those who may greatly benefit from folic acid treatment,in particular,those with the TT genotype,a subpopulation known to have the highest stroke risk.展开更多
基金supported by the National Nature Science Foundation of China(82330021,82061160372,82270771)the National Key Research and Development Program(2020YFC2004405)+13 种基金the Shenzhen Key Laboratory of Precision Prevention and Control of Major Chronic Diseases and Metabolic Research(ZDSYS20220606100801004)the Central Military Commission Key Project of Basic Research for Application(BWJ21J003)the Regional Joint Funding Key Project of Guangdong Basic Research and Basic Research for Application(2021B1515120083)the Key Project of Sustainable Development Science and Technology of Shenzhen Science and Technology Innovation Committee(KCXFZ20211020163801002)Shenzhen Science and Technology Program(ZDSYS20220606100801004,SGDX20230116092459009)Shenzhen Medical Research Fund(B2302020)Shenzhen Key Medical Discipline Construction Fund(SZXK002)the Sun Yat-sen University-Shenzhen TAILORED Medical Ltd.Postgraduate joint training base,the Futian District Public Health Scientific Research Project of Shenzhen(FTWS2022001)Department of Cardiology,Joint Laboratory of Guangdong-Hong Kong-Macao Universities for Nutritional Metabolism and Precise Prevention and Control of Major Chronic Diseases,the Eighth Affiliated Hospital of Sun Yat-sen University,Shenzhen,the Chinese Association of Integrative Medicine-Shanghai Hutchison Pharmaceuticals Fund(HMPE202202)China Heart House-Chinese Cardiovascular Association HX fund(2022-CCA-HX-090)the Shenzhen Key Medical Discipline Construction Fund(SZXK002)to H.HShenzhen Medical Research Fund(A2302013)to Zhengzhipeng ZhangThe fifth“333”high-level talent training project of Jiangsu Province(BRA2019247)Medical Research Project of Jiangsu Provincial Health Commission in 2020(ZDA2020018).
文摘Previous studies have shown that low platelet count combined with high plasma total homocysteine(tHcy)increased stroke risk and can be lowered by 73% with folic acid.However,the combined role of other platelet activation parameters and the methylenetetrahydrofolate reductase(MTHFR)C677T genotypes on stroke risk and folic acid treatment benefit remain to be examined.This study aimed to investigate if platelet activation parameters and MTHFR genotypes jointly impact folic acid treatment efficacy in first stroke prevention.Data were derived from the China Stroke Primary Prevention Trial.This study includes a total of 11,185 adult hypertensive patients with relevant platelet activation parameters and MTHFR genotype data.When simultaneously considering both platelet activation parameters(plateletcrit,platelet count,mean platelet volume,platelet distribution width)and MTHFR genotypes,patients with both low plateletcrit(Q1)and the TT genotype had the highest stroke incidence rate(5.6%)in the enalapril group.This subgroup significantly benefited from folic acid treatment,with a 66% reduction in first stroke(HR:0.34;95%CI:0.14-0.82;p=0.016).Consistently,the subgroup with low plateletcrit(Q1)and the CC/CT genotype also benefited from folic acid treatment(HR:0.40;95%CI:0.23-0.70;p=0.001).In Chinese hypertensive adults,low plateletcrit can identify those who may greatly benefit from folic acid treatment,in particular,those with the TT genotype,a subpopulation known to have the highest stroke risk.
