Plasma selenium and the risk of first stroke in adults with hypertension: a secondary analysis of the China Stroke Primary Prevention Trial
Zhuo Wang, Hai Ma, Yun Song, Tengfei Lin, Lishun Liu, Ziyi Zhou, Yaping Wei, Xiao Huang, Ping Chen, Chengzhang Liu, Youbao Li, Binyan Wang, Jianping Li, Yan Zhang, Yong Huo, Hao Zhang, Xiping Xu, Xianhui Qin, Huiyuan Guo, Zhuo Wang, Hai Ma, Yun Song, Tengfei Lin, Lishun Liu, Ziyi Zhou, Yaping Wei, Xiao Huang, Ping Chen, Chengzhang Liu, Youbao Li, Binyan Wang, Jianping Li, Yan Zhang, Yong Huo, Hao Zhang, Xiping Xu, Xianhui Qin, Huiyuan Guo
Abstract
Background: Previous studies have indicated that selenium (Se) may play an important role in cardio-cerebrovascular disease. However, the relation between circulating selenium and risk of first stroke remains inconclusive.
Objectives: We conducted a secondary analysis of the China Stroke Primary Prevention Trial (CSPPT), using a nested case-control design, and aimed to investigate the correlation between Se concentration and first stroke risk in adults with hypertension and examine the potential effect modifiers.
Methods: In the CSPPT, a total of 20,702 adults with hypertension were randomly assigned to a double-blind daily treatment with either 10 mg enalapril and 0.8 mg folic acid or 10 mg enalapril alone. A total of 618 first stroke cases and 618 controls matched for age, sex, treatment group, and study site were included in this study.
Results: During a median follow-up duration of 4.5 y (IQR: 4.2-4.6 y), there was a significant inverse association between plasma Se and the risk of first stroke (per SD increment; adjusted OR: 0.81; 95% CI: 0.68, 0.96) and ischemic stroke (per SD increment; adjusted OR: 0.76; 95% CI: 0.62, 0.93). Furthermore, a stronger inverse association between plasma Se and first stroke was observed in participants with higher folate concentrations at baseline [≥7.7 ng/mL (median), adjusted OR: 0.67; 95% CI: 0.54, 0.85, compared with <7.7 ng/mL, adjusted OR: 0.98; 95% CI: 0.80, 1.21; P-interaction = 0.008] and those with higher time-averaged systolic blood pressure (SBP) over the treatment period (≥140 mm Hg, adjusted OR: 0.71; 95% CI: 0.58, 0.86, compared with <140 mm Hg, adjusted OR: 0.96; 95% CI: 0.77, 1.20; P-interaction = 0.023).
Conclusions: There was a significant inverse association between plasma Se and risk of first stroke in Chinese adults with hypertension, especially among those with higher baseline folate concentrations and those with higher time-averaged SBP over the treatment period. This trial was registered at clinicaltrials.gov as NCT00794885.
Keywords: first stroke; folate; hypertension; risk factor; selenium; systolic blood pressure.
© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.
Source: PubMed