Rajaratnam R A, Gylling H, Miettinen T A
Department of Medicine, University of Helsinki, Finland.
J Am Coll Cardiol. 2000 Apr;35(5):1185-91. doi: 10.1016/s0735-1097(00)00527-1.
The purpose of the study was to investigate whether cholesterol metabolism is associated with coronary artery disease (CAD) in postmenopausal women.
Although hypercholesterolemia, a predominant risk factor of CAD, is related to cholesterol metabolism, the association between cholesterol metabolism and CAD is not well known.
In addition to conventional coronary risk factors, fasting serum squalene, delta8-cholestenol, desmosterol, lathosterol (indicators of cholesterol synthesis), cholestanol, campesterol and sitosterol (indicators of cholesterol absorption) were measured in 48 50- to 55-year-old consecutive women with angiographically verified CAD and in 61 age-matched healthy controls.
The coronary patients had elevated ratios of squalene (p < 0.001), desmosterol (p = 0.005), campesterol (p = 0.028) and sitosterol (p = 0.022) to cholesterol, but had lower respective lathosterol value (p = 0.041) compared with the controls, despite similar serum cholesterol levels. Adjusted for age, body mass index, family history of CAD, smoking, hypertension, serum triglycerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol level and glycosylated hemoglobin A1c% (GHbA1c), the ratios of squalene (odds ratio, 1.36; 95% confidence interval, 1.17 to 1.57), lathosterol (0.98; 0.97 to 0.99), campesterol (1.01; 1.00 to 1.01) and sitosterol (1.01; 1.00 to 1.03) were significantly associated with the risk of CAD. In addition, family history of CAD and GHbA1c% were also independently related to the presence of CAD.
The results suggest that women with elevated ratios of serum squalene, campesterol and sitosterol to cholesterol and low respective lathosterol values have enhanced risk for CAD. Thus, enhanced absorption and reduced synthesis of cholesterol may be related to coronary atherosclerosis.
本研究旨在调查绝经后女性的胆固醇代谢是否与冠状动脉疾病（CAD）相关。
尽管高胆固醇血症是CAD的主要危险因素，与胆固醇代谢有关，但胆固醇代谢与CAD之间的关联尚不清楚。
除了传统的冠状动脉危险因素外，还对48名年龄在50至55岁、经血管造影证实患有CAD的连续女性以及61名年龄匹配的健康对照者测量了空腹血清角鲨烯、δ8-胆甾烯醇、去氢胆固醇、羊毛甾醇（胆固醇合成指标）、胆甾烷醇、菜油甾醇和豆甾醇（胆固醇吸收指标）。
尽管血清胆固醇水平相似，但与对照组相比，冠心病患者的角鲨烯（p < 0.001）、去氢胆固醇（p = 0.005）、菜油甾醇（p = 0.028）和豆甾醇（p = 0.022）与胆固醇的比值升高，而各自的羊毛甾醇值较低（p = 0.041）。在调整年龄、体重指数、CAD家族史、吸烟、高血压、血清甘油三酯、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）胆固醇水平以及糖化血红蛋白A1c%（GHbA1c）后，角鲨烯（比值比，1.36；95%置信区间，1.17至1.57）、羊毛甾醇（0.98；0.97至0.99）、菜油甾醇（1.01；1.00至1.01）和豆甾醇（1.01；1.00至1.03）的比值与CAD风险显著相关。此外，CAD家族史和GHbA1c%也与CAD的存在独立相关。
结果表明，血清角鲨烯、菜油甾醇和豆甾醇与胆固醇比值升高且各自羊毛甾醇值较低的女性患CAD的风险增加。因此，胆固醇吸收增加和合成减少可能与冠状动脉粥样硬化有关。
