A Threshold Study of Carotid Plaque Risk in Postmenopausal Middle-aged Women with Normal Homocysteine

doi:10.12114/j.issn.1007-9572.2023.0677

Abstract

Abstract:

Background

Carotid plaque is an important early predictive signal of clinical carotid atherosclerosis, the association between homocysteine (Hcy) and carotid plaque is well recognized, however, the correlation between Hcy and carotid plaque in postmenopausal middle-aged women is not established.

Objective

To analyze the impact of Hcy within the normal reference range on the risk of carotid plaque in postmenopausal middle-aged women and determine the risk threshold.

Methods

A total of 1 465 postmenopausal women (Hcy<15 μmol/L) who underwent health examinations at the Affiliated Hospital of Guizhou Medical University between January 2020 and June 2023 were randomly selected. The general information, blood biochemical indicators, and carotid ultrasound indicators of patients were collected, and multivariate Logistic regression analysis was used to explore the association between Hcy and carotid plaque. The cutoff value of Hcy for predicting the risk of carotid plaque in postmenopausal middle-aged women with normal Hcy range was determined by plotting the receiver operating characteristic (ROC) curve.

Results

Six hundred and forty-four (43.96%) out of 1 465 study subjects had carotid artery plaques. Age, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triacylglycerol (TG), and Hcy were higher in the plaque group than in the non-plaque group, high-density lipoprotein cholesterol (HDL-C) was lower than in the non-plaque group (P<0.05). Logistic regression analysis showed that age (OR=1.100, 95%CI=1.070-1.130), SBP (OR=1.021, 95%CI=1.012-1.030), LDL-C (OR=1.232, 95%CI=1.077-1.411), HDL-C (OR=0.568, 95%CI=0.387-0.835) and Hcy (OR=1.142, 95%CI=1.080-1.207) were independent risk factors for carotid plaque in postmenopausal middle-aged women. ROC curve analysis indicated that Hcy≥11.87 μmol/L was the optimal cutoff value for predicting carotid plaque in postmenopausal middle-aged women within the normal Hcy range, with the area under curve (AUC) of 0.605, specificity of 75.8% and sensitivity of 40.4%.

Conclusion

Hcy is an independent risk factor for carotid plaque in postmenopausal middle-aged women, and Hcy≥11.87 μmol/L is the optimal cutoff value for predicting carotid plaque in postmenopausal middle-aged women with normal Hcy. This threshold may provide an important reference for clinical assessment of carotid plaque risk in postmenopausal middle-aged women.

Key words: Carotid plaques, Carotid stenosis, Postmenopause, Homocysteine, Threshold

摘要：

背景

颈动脉斑块是临床颈动脉粥样硬化的重要早期预测信号，同型半胱氨酸（Hcy）与颈动脉斑块之间的联系已被公认，但目前对绝经后中老年女性Hcy与颈动脉斑块的相关性尚无明确的定论。

目的

分析绝经后中老年女性Hcy在参考范围对颈动脉斑块发生的风险影响，确定其风险阈值。

方法

选取2020年1月—2023年6月于贵州医科大学附属医院体检中心行健康体检的正常Hcy绝经后中老年女性1 465例（Hcy<15 μmol/L）。收集研究对象一般情况、血液生化指标和颈动脉超声指标，采用多因素Logistic回归分析探讨Hcy与颈动脉斑块的关联。利用受试者工作（ROC）曲线确定正常Hcy绝经后中老年女性发生颈动脉斑块风险的Hcy截断值。

结果

1 465例研究对象中有颈动脉斑块644例（43.96%）。斑块者年龄、收缩压、舒张压、总胆固醇、三酰甘油、Hcy均高于非斑块者，高密度脂蛋白胆固醇低于非斑块者（P<0.05）。多因素Logistic回归分析结果显示，年龄（OR=1.100，95%CI=1.070~1.130）、收缩压（OR=1.021，95%CI=1.012~1.030）、低密度脂蛋白胆固醇（OR=1.232，95%CI=1.077~1.411）、高密度脂蛋白胆固醇（OR=0.568，95%CI=0.387~0.835）和Hcy（OR=1.142，95%CI=1.080~1.207）是绝经后中老年女性发生颈动脉斑块的独立影响因素（P<0.05）。ROC曲线分析显示，Hcy≥11.87 μmol/L是预测正常Hcy绝经后中老年女性患颈动脉斑块的最佳截断值，ROC曲线下面积为0.605，特异度为75.8%，灵敏度为40.4%。

结论

Hcy是绝经后中老年女性发生颈动脉斑块的独立影响因素，且Hcy≥11.87 μmol/L是预测绝经后中老年女性在Hcy正常水平内发生颈动脉斑块的最佳截断值。这一阈值可为临床评估绝经后中老年女性颈动脉斑块风险提供重要参考。

关键词: 颈动脉斑块, 颈动脉狭窄, 绝经后女性, 同型半胱氨酸, 阈值

LU Ran,WU Chunyan,XU Haina, et al. A Threshold Study of Carotid Plaque Risk in Postmenopausal Middle-aged Women with Normal Homocysteine[J]. Chinese General Practice, 2024, 27(11): 1320-1325. DOI: 10.12114/j.issn.1007-9572.2023.0677.
卢然,吴春艳,许海娜等. 正常同型半胱氨酸绝经后中老年女性发生颈动脉斑块风险的阈值研究[J]. 中国全科医学, 2024, 27(11): 1320-1325. DOI: 10.12114/j.issn.1007-9572.2023.0677.

Figures/Tables 4

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变量	非斑块者（n=821）	斑块者（n=644）	t值	P值
年龄（岁）	57.4±4.7	59.9±4.2	10.471	<0.001
BMI（kg/m²）	23.3±7.1	23.7±3.1	1.425	0.154
SBP（mmHg）	120±17	128±17	9.045	<0.001
DBP（mmHg）	72±10	75±10	4.726	<0.001
TC（mmol/L）	5.07±0.83	5.15±0.94	1.776	0.076
TG（mmol/L）	1.58±1.18	1.76±1.14	2.927	<0.001
LDL-C（mmol/L）	3.16±0.75	3.27±0.90	2.528	0.012
HDL-C（mmol/L）	1.49±0.34	1.41±0.30	-7.548	<0.001
Hcy（μmol/L）	10.47±2.05	11.21±1.99	7.008	<0.001

变量	非斑块者（n=821）	斑块者（n=644）	t值	P值
年龄（岁）	57.4±4.7	59.9±4.2	10.471	<0.001
BMI（kg/m²）	23.3±7.1	23.7±3.1	1.425	0.154
SBP（mmHg）	120±17	128±17	9.045	<0.001
DBP（mmHg）	72±10	75±10	4.726	<0.001
TC（mmol/L）	5.07±0.83	5.15±0.94	1.776	0.076
TG（mmol/L）	1.58±1.18	1.76±1.14	2.927	<0.001
LDL-C（mmol/L）	3.16±0.75	3.27±0.90	2.528	0.012
HDL-C（mmol/L）	1.49±0.34	1.41±0.30	-7.548	<0.001
Hcy（μmol/L）	10.47±2.05	11.21±1.99	7.008	<0.001

因素	β	SE	Wald χ²值	P值	OR值	95%CI
年龄	0.095	0.014	47.530	<0.001	1.100	1.070~1.130
SBP	0.021	0.005	19.749	<0.001	1.021	1.012~1.030
DBP	-0.003	0.007	0.127	0.721	0.997	0.983~1.012
TG	-0.006	0.054	0.012	0.914	0.994	0.895~1.104
LDL-C	0.209	0.069	9.200	0.002	1.232	1.077~1.411
HDL-C	-0.565	0.196	8.305	0.004	0.568	0.387~0.835
Hcy	0.133	0.028	21.920	<0.001	1.142	1.080~1.207

因素	β	SE	Wald χ²值	P值	OR值	95%CI
年龄	0.095	0.014	47.530	<0.001	1.100	1.070~1.130
SBP	0.021	0.005	19.749	<0.001	1.021	1.012~1.030
DBP	-0.003	0.007	0.127	0.721	0.997	0.983~1.012
TG	-0.006	0.054	0.012	0.914	0.994	0.895~1.104
LDL-C	0.209	0.069	9.200	0.002	1.232	1.077~1.411
HDL-C	-0.565	0.196	8.305	0.004	0.568	0.387~0.835
Hcy	0.133	0.028	21.920	<0.001	1.142	1.080~1.207

Hcy分组	β	SE	Wald χ²值	P值	OR值	95%CI
Q1					1.000
Q2	0.453	0.167	7.341	0.007	1.573	1.134~2.183
Q3	0.383	0.167	5.288	0.021	1.467	1.058~2.033
Q4	0.805	0.169	22.752	<0.001	2.238	1.607~3.116