Association of serum choline levels and all-cause mortality risk in adults with hypertension: a nested case-control study

Mengmeng Song, Benjamin P Xu, Qiongyue Liang, Yaping Wei, Yun Song, Ping Chen, Ziyi Zhou, Nan Zhang, Qiangqiang He, Lishun Liu, Tong Liu, Kangping Zhang, Chunlei Hu, Binyan Wang, Xiping Xu, Hanping Shi, Mengmeng Song, Benjamin P Xu, Qiongyue Liang, Yaping Wei, Yun Song, Ping Chen, Ziyi Zhou, Nan Zhang, Qiangqiang He, Lishun Liu, Tong Liu, Kangping Zhang, Chunlei Hu, Binyan Wang, Xiping Xu, Hanping Shi

Abstract

Background: Serum choline levels were associated with multiple chronic diseases. However, the association between serum choline and all-cause mortality in Chinese adults with hypertension remains unclear. The purpose of this study is to explore the association between serum choline concentrations and all-cause mortality risk in Chinese adults with hypertension, a high-risk population.

Methods: A nested, case-control study was conducted that included 279 patients with all-cause death, and 279 matched, living controls, derived from the China Stroke Primary Prevention Trial (CSPPT). Baseline serum choline concentrations were measured by liquid chromatography with tandem quadrupole mass spectrometry (LC-MS/MS). Multivariate logistic regression analysis was used to assess the association of serum choline levels and all-cause mortality risk, with adjustment of pertinent covariables, including folic acid and homocysteine.

Results: The median age of all participants was 64.13 years [interquartile range (IQR), 57.33-70.59 years]. The median serum choline concentration for cases (9.51 μg/mL) was higher than that in controls (7.80 μg/mL) (P = 0.009). When serum choline concentration was assessed as a continuous variable (per SD increased), there was a positive relation between serum choline levels and all-cause mortality risk [odds ratios (OR), 1.29; 95% confidence intervals (95%CI), 1.06-1.57; P = 0.010]. There was an increased all-cause mortality risk for participants in quartiles 2-4 (≥ 4.00 μg/mL; OR, 1.79; 95%CI, 1.15-2.78 compared with quartile 1 (< 4.00 μg/mL). In addition, non-drinking was found to promote the incidence of all-cause mortality for those with high choline concentrations.

Conclusions: High serum choline concentrations were associated with increased all-cause mortality risk among Chinese adults with hypertension, compared to lower choline concentrations. Trial registration clinicaltrials.gov Identifier: NCT007948885; UTL: https://ichgcp.net/clinical-trials-registry/NCT00794885?term=NCT00794885&draw=2&rank=1.

Keywords: All-cause mortality; Hypertension; Nested case–control; Serum choline.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart of study participants
Fig. 2
Fig. 2
The association between baseline serum choline and all-cause mortality risk of participants. The splines were adjusted for body mass index, month of collecting blood samples, smoking, alcohol drinking, MTHFR C677T, systolic blood pressure, triglyceride, cholesterol, uric acid, folic acid, baseline fasting blood glucose, homocysteine and the matching factors (age, sex, treatment group)
Fig. 3
Fig. 3
The association between serum choline concentrations and all-cause mortality risk in various subgroups. The association between serum choline and all-cause mortality risk in various subgroups in the nested case–control study within the China Stroke Primary Prevention Trial, conducted between May 2008 and August 2013. Adjusted for age, BMI, sex, treatment group, smoking status, alcohol drinking, MTHFR C677T, systolic blood pressure, triglyceride, cholesterol, uric acid, glucose, homocysteine, folic acid levels and month of collecting blood samples, if not stratified. OR, odds ratio. 95%CI, 95% confidence interval
Fig. 4
Fig. 4
Interaction effect associations of baseline serum choline and alcohol with all-cause mortality risk

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