Association of L-alpha Glyceryiphosphoryicholine With Subsequent Stroke Risk After 10 Years

IMPORTANCE L-alpha glycerylphosphorylcholine (alpha-GPC, choline alphoscerate) is used globally by individuals older than 50 years based on its potential function as a precursor of acetylcholine. However, choline has previously been linked to a higher risk of cardiovascular disease via trimethylamine-N-oxide, a metabolite of choline by microbiota. OBJECTIVE To investigate the association between alpha-G PC use and subsequent 10-year stroke risk. DESIGN, SETTING, AND PARTICIPANTS A population-based, retrospective cohort study was conducted using data from the National Health Insurance Service of South Korea. Participants included men and women aged 50 years or older without underlying stroke or Alzheimer disease (N = 12 008 977). MAIN OUTCOMES AND MEASURES All participants were divided into whether they were prescribed alpha-GPC during 2006-2008. alpha-GPC users were matched with nonusers for all covariates to create a matched cohort. alpha-GPC use was further divided into durations less than 2, 2 to 6, 6 to 12, and more than 12 months of alpha-GPC prescriptions. The adjusted hazard ratios (a H Rs) and 95% Cls for total stroke, ischemic stroke, and hemorrhagic stroke from January 1, 2009, to January 31, 2018, were calculated by multivariate Cox proportional hazards regression. RESULTS A total of 12 008 977 individuals (6401965 [53.3%] women) aged 50 years or older were included in the study. The mean (SD) age was 61.6 (9.4) years for nonusers and 68.3 (10.0) years for users, and that of the matching cohort was 682 (9.9) years for both groups. Compared with alpha-GPC nonusers (n = 11 900 100), users (n = 108 877) had a higher risk for total stroke (aHR, 1.46; 95% CI, 1.43-1.48), ischemic stroke (aHR 136; 95% CI, 1.33-1.39), and hemorrhagic stroke (aHR, 1.36; 95% CI, 1.28-1.44). After matching for all covariates, alpha-GPC users had a higher risk for total stroke (aHR, 1.43; 95% CI, 1.41-1.46), ischemic stroke (aHR, 1.34; 95% CI, 1.31-1.37), and hemorrhagic stroke (aHR, 1.37; 95% CI, 1.29-1.46). Increasing intake of alpha-GPC was associated with a higher risk for total stroke in a dose-response manner. CONCLUSIONS AND RELEVANCE In this cohort study, use of alpha-GPC was associated with a higher 10-year incident stroke risk in a dose-response manner after adjusting for traditional cerebrovascular risk factors. Future studies are needed to determine the possible mechanisms behind the potential cerebrovascular risk-elevating effects of alpha -GPC.

Automated summary

A study conducted in South Korea found that the use of alpha-GPC was associated with a higher 10-year stroke risk in a dose-response manner. Alpha-GPC users had a higher risk for both ischemic and hemorrhagic stroke compared to nonusers. Further research is needed to understand the mechanisms behind this potential cerebrovascular risk.