van Exel Eric, de Craen Anton J M, Gussekloo Jacobijn, Houx Peter, Bootsma-van der Wiel Annetje, Macfarlane Peter W, Blauw Gerard J, Westendorp Rudi G J
Section of Gerontology and Geriatrics, Department of General Internal Medicine, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
Ann Neurol. 2002 Jun;51(6):716-21. doi: 10.1002/ana.10220.
Low high-density lipoprotein cholesterol is associated with an increased risk for cardiovascular disease and stroke. At the same time, cardiovascular disease and stroke are important risk factors for dementia. We assessed the association between total and fractionated cholesterol and cognitive impairment and explored whether observed associations were dependent on or independent of atherosclerotic disease. In a population-based study, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured in 561 subjects 85 years old and grouped in three equal strata representing decreasing serum concentrations. History of cardiovascular disease and stroke was determined. All subjects completed the Mini-Mental State Examination (MMSE), and the presence of dementia was determined. Median MMSE scores were significantly lower in subjects with low high-density lipoprotein cholesterol (25 points vs 27 points, p < 0.001). No differences in MMSE scores were found for other lipids and lipoproteins. MMSE scores in subjects with and without cardiovascular disease were 26 and 27 points (p = 0.007), respectively, and in subjects with and without stroke were 21 and 26 points (p < 0.001), respectively. The associations between low MMSE scores and low high-density lipoprotein cholesterol remained significant after subjects with cardiovascular disease or stroke were excluded. In a comparison of subjects with low high-density lipoprotein cholesterol with subjects with high high-density lipoprotein cholesterol, the odds ratio for dementia was 2.3 (95% confidence interval, 1.2-4.3), and in subjects without cardiovascular disease or stroke, it was 3.7 (95% confidence interval, 1.3-10.1). All odds ratios were unaffected by education, low-density lipoprotein cholesterol, triglycerides, and survival. Low high-density lipoprotein cholesterol is associated with cognitive impairment and dementia. At least part of the association between high-density lipoprotein cholesterol and cognitive function is independent of atherosclerotic disease.
低密度脂蛋白胆固醇水平低与心血管疾病和中风风险增加相关。同时，心血管疾病和中风是痴呆症的重要风险因素。我们评估了总胆固醇及胆固醇各组分与认知障碍之间的关联，并探讨了观察到的关联是否依赖于动脉粥样硬化疾病或与之无关。在一项基于人群的研究中，对561名85岁的受试者测量了总胆固醇、甘油三酯、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇，并将其分为血清浓度递减的三个相等分层。确定了心血管疾病和中风病史。所有受试者均完成简易精神状态检查表（MMSE），并确定是否患有痴呆症。低密度脂蛋白胆固醇水平低的受试者的MMSE评分中位数显著更低（25分对27分，p<0.001）。其他脂质和脂蛋白的MMSE评分未发现差异。有和没有心血管疾病的受试者的MMSE评分分别为26分和27分（p = 0.007），有和没有中风的受试者的MMSE评分分别为21分和26分（p<0.001）。排除患有心血管疾病或中风的受试者后，低MMSE评分与低高密度脂蛋白胆固醇之间的关联仍然显著。在低密度脂蛋白胆固醇水平低的受试者与高密度脂蛋白胆固醇水平高的受试者的比较中，痴呆症的比值比为2.3（95%置信区间，1.2 - 4.3），在没有心血管疾病或中风的受试者中，比值比为3.7（95%置信区间，1.3 - 10.1）。所有比值比均不受教育程度、低密度脂蛋白胆固醇、甘油三酯和生存情况的影响。低密度脂蛋白胆固醇水平低与认知障碍和痴呆症相关。高密度脂蛋白胆固醇与认知功能之间的关联至少部分独立于动脉粥样硬化疾病。
