Choline, betaine lower risks of cardiovascular events, recurrent stroke after ischaemic stroke

Plasma choline pathway metabolites, including choline and betaine, appear to reduce the risks of cardiovascular events and recurrent stroke, as well as offer incremental value in risk discrimination and stratification in patients with ischaemic stroke, suggests a recent study.

A team of investigators conducted a nested case-control study within the China Antihypertensive Trial in Acute Ischemic Stroke, including 323 cardiovascular events (with 264 recurrent strokes) and 323 controls (free of recurrent cardiovascular events) matched for age, sex, and treatment group. A composite of cardiovascular events after ischaemic stroke was the primary endpoint.

The investigators measured plasma choline and betaine at baseline by ultra-high-performance liquid chromatography mass spectrometry. They then applied conditional logistic regression models and evaluated discrimination, reclassification, and calibration of models with choline pathway metabolites.

Plasma choline and betaine inversely correlated with cardiovascular events and recurrent stroke following ischaemic stroke. In fully adjusted models, each additional standard deviation of choline and betaine correlated with 35-percent (95 percent confidence interval [CI], 20–48) and 30-percent (95 percent CI, 14–43) lower risks of subsequent cardiovascular events, respectively, and 34-percent (95 percent CI, 16–48) and 29-percent (95 percent CI, 12–43) reduced risks of recurrent stroke, respectively.

Both choline and betaine also provided substantial risk discrimination and reclassification improvement for cardiovascular events and recurrent stroke beyond traditional risk factors, as shown by an increase in C statistics, the net reclassification index, and integrated discrimination improvement.

“Choline and betaine have been suggested to play a pivotal role in neurotransmitter synthesis, cell membrane integrity, and methyl-group metabolism, exerting neuroprotective effects in patients with various neurological disorders,” the investigators said.