Serum L-Carnitine Levels Are Associated With First Stroke in Chinese Adults With Hypertension

Author:

Zhou Ziyi12ORCID,Zhang Nan3,Song Yun24,Liu Lishun12,Li Jianping3ORCID,Zhang Yan3ORCID,Huo Yong3,Liu Xiangyi5,Duan Yong6,Wang Binyan4,Zhang Hao2,Guo Huiyuan2,Qin Xianhui7ORCID,Wang Xiaobin8ORCID,Xu Xiping27ORCID

Affiliation:

1. Tsinghua Shenzhen International Graduate School, Tsinghua University, China (Z.Z., L.L.).

2. Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing (Z.Z., Y.S., L.L., H.Z., H.G., X.X.).

3. Department of Cardiology, Peking University First Hospital, Beijing, China (N.Z., J.L., Y.Z., Y.H.).

4. Institute for Biomedicine, Anhui Medical University, Hefei, China (Y.S., B.W.).

5. Beijing Tongren Hospital, Capital Medical University, China (X.L.).

6. First Affiliated Hospital of Kunming Medical University, China (Y.D.).

7. Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., X.X.).

8. Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.).

Abstract

Background: This study aimed to evaluate the association of serum L-carnitine with first stroke and explore potential effect modifiers. Methods: This is a nested, case-control study drawn from the China Stroke Primary Prevention Trial among rural Chinese adults with hypertension, including 557 first stroke cases and 557 age-matched, sex-matched, treatment group–matched, and residence-matched controls. Serum L-carnitine was measured by liquid chromatography with tandem quadrupole mass spectrometry. Multiple conditional logistic regression models were used to evaluate the association between L-carnitine and first stroke. Results: The mean level of serum L-carnitine in the stroke population was 4.7 μg/mL, which was significantly lower than that of the control group (5.7 μg/mL). When L-carnitine was assessed as quintiles, compared with the reference group (quintile 1, <3.3 μg/mL), the odds of stroke were 0.62 (95% CI, 0.39–1.00) in quintile 2, 0.66 (95% CI, 0.40–1.10) in quintile 3, 0.47 (95% CI, 0.28–0.81) in quintile 4, and 0.50 (95% CI, 0.30–0.84) in quintile 5. The trend test was significant ( P =0.01). When quintiles 2 to 5 were combined, the adjusted odds ratio of first stroke was 0.58 (95% CI, 0.38–0.87) compared with quintile 1. Similar associations were found for ischemic stroke and hemorrhagic stroke. In subgroup analysis, a significant L-carnitine–stroke association was only observed in the normal folate group ( P interaction, 0.039) and in the MTHFR CC genotype group ( P interaction, 0.047). Conclusions: In this study of rural Chinese adults with hypertension, serum L-carnitine had an inverse but nonlinear association with first stroke. Folate status and the MTHFR C677T variant were significant effect modifiers of the association.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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