Nelson Jennifer Clark, Jiang Xian-Cheng, Tabas Ira, Tall Alan, Shea Steven
Center for Health Studies, Group Health Cooperative, and Department of Biostatistics, University of Washington, Seattle, USA.
Am J Epidemiol. 2006 May 15;163(10):903-12. doi: 10.1093/aje/kwj140. Epub 2006 Apr 12.
Plasma sphingomyelin has been shown to be an independent risk factor for coronary heart disease, but the relation of plasma sphingomyelin to earlier, subclinical atherosclerotic disease has not been reported. The authors examined the association between plasma sphingomyelin and three measures of subclinical cardiovascular disease (carotid intimal-medial wall thickness, ankle-arm blood pressure index, and Agatston coronary artery calcium score) among 6,814 middle-aged, asymptomatic adults in the Multi-Ethnic Study of Atherosclerosis, which was initiated in 2000. The sphingomyelin level was positively correlated with lipids and the Framingham risk score (p < 0.01 for both), and the mean level was higher in women than men (50 (standard deviation (SD), 16) vs. 45 (SD, 15) mg/dl) (p < 0.01) and higher in never versus current smokers (49 (SD, 16) vs. 45 (SD, 17) mg/dl) (p < 0.01). Women with sphingomyelin levels of 60 or more mg/dl had more severe subclinical disease by all three measures than did the referent group with sphingomyelin levels of 39 or less mg/dl, although associations were not significant after multivariate adjustment for standard cardiovascular disease risk factors. Men with sphingomyelin levels of 60 or more mg/dl versus those with sphingomyelin levels of 39 or less mg/dl had higher calcium scores (135 vs. 99 Agatston units) (p = 0.01). These observations are consistent with the hypothesis that plasma sphingomyelin is in the biologic pathway that mediates the risk for subclinical disease attributable to standard cardiovascular disease risk factors.
血浆鞘磷脂已被证明是冠心病的独立危险因素，但血浆鞘磷脂与早期亚临床动脉粥样硬化疾病的关系尚未见报道。作者在2000年启动的动脉粥样硬化多族裔研究中，对6814名中年无症状成年人的血浆鞘磷脂与亚临床心血管疾病的三项指标（颈动脉内膜中层厚度、踝臂血压指数和阿加斯顿冠状动脉钙化评分）之间的关联进行了研究。鞘磷脂水平与血脂和弗雷明汉风险评分呈正相关（两者p均<0.01），女性的平均水平高于男性（50（标准差[SD]，16）对45（SD，15）mg/dl）（p<0.01），从不吸烟者高于当前吸烟者（49（SD，16）对45（SD，17）mg/dl）（p<0.01）。鞘磷脂水平≥60mg/dl的女性，与鞘磷脂水平≤39mg/dl的参照组相比，所有三项指标的亚临床疾病都更严重，尽管在对标准心血管疾病危险因素进行多变量调整后，关联并不显著。鞘磷脂水平≥60mg/dl的男性与鞘磷脂水平≤39mg/dl的男性相比，钙化评分更高（135对99阿加斯顿单位）（p=0.01）。这些观察结果与以下假设一致，即血浆鞘磷脂处于介导由标准心血管疾病危险因素导致的亚临床疾病风险的生物学途径中。
