Department of Internal Medicine/Cardiology, University of Virginia Medical Center, Charlottesville, VA 22908, USA.
Arterioscler Thromb Vasc Biol. 2010 Mar;30(3):628-33. doi: 10.1161/ATVBAHA.109.199281. Epub 2009 Dec 23.
A high plasma sphingomyelin level has been associated with subclinical atherosclerosis, coronary artery disease, and worse prognosis in subjects with acute coronary syndromes. We wanted to assess the predictive value of plasma sphingomyelin levels for incident coronary heart disease (CHD) events in the Multi-Ethnic Study of Atherosclerosis.
The plasma sphingomyelin level was measured in 6809 of 6814 subjects (age, mean+/-SD, 62.2+/-10.2 years) participating in the Multi-Ethnic Study of Atherosclerosis, a population-based cohort study of adults free of clinical cardiovascular disease at baseline recruited at 6 clinic sites in the United States. The subjects consisted of 52.8% females, 38.5% whites, 11.8% Chinese, 27.8% blacks, and 21.9% Hispanics. Cox proportional hazard analysis was used to examine the association between plasma sphingomyelin level and 5 years of adjudicated incident CHD events, including myocardial infarction, resuscitated cardiac arrest, angina, CHD-related death, and revascularization (coronary artery bypass grafting or percutaneous transluminal coronary angioplasty). The mean+/-SD plasma sphingomyelin level was 48.0+/-16.0 mg/dL. A total of 189 subjects had an adjudicated CHD event during the 5 years of follow-up. In the Kaplan-Meier analysis, subjects with a plasma sphingomyelin level higher than the sex-specific median had a similar event-free survival rate compared with subjects with a plasma sphingomyelin level at or less than the sex-specific median (97.16% versus 97.00%; log rank P=0.71). In the univariate Cox proportional hazard analysis, the plasma sphingomyelin level was not a predictor of an incident CHD event (hazard ratio, 0.992 [0.982-1.004]; P=0.09). In our multistage multivariate Cox proportional hazard models, a higher plasma sphingomyelin level had a modest negative association with incident CHD events when total cholesterol, high-density lipoprotein, and triglycerides were included in the model (hazard ratio, 0.985 [0.973-0.996]; P=0.008) and also in our full model after adjusting for age, sex, total cholesterol, high-density lipoprotein, triglycerides, diabetes mellitus, cigarette smoking, systolic and diastolic blood pressure, medication use for blood pressure, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor use (hazard ratio, 0.984 [0.973-0.996]; P=0.002). In other models, the plasma sphingomyelin level was not associated with incident CHD events.
A high plasma sphingomyelin level is not associated with an increased risk of incident CHD in population-based adults free of clinical cardiovascular disease at baseline.
较高的血浆神经鞘磷脂水平与亚临床动脉粥样硬化、冠心病以及急性冠脉综合征患者的预后不良相关。我们旨在评估多发性动脉粥样硬化研究中的血浆神经鞘磷脂水平对新发冠心病（CHD）事件的预测价值。
在多发性动脉粥样硬化研究中，对 6814 例符合条件的患者（年龄为 62.2+/-10.2 岁）中的 6809 例（52.8%为女性，38.5%为白人，11.8%为中国人，27.8%为黑人，21.9%为西班牙裔）的血浆神经鞘磷脂水平进行了测量。该研究是一项基于人群的队列研究，参与者在基线时均无临床心血管疾病，在美国的 6 个临床中心招募。采用 Cox 比例风险分析来研究血浆神经鞘磷脂水平与 5 年经裁定的新发 CHD 事件（包括心肌梗死、复苏性心脏骤停、心绞痛、CHD 相关死亡和血运重建（冠状动脉旁路移植术或经皮腔内冠状动脉血管成形术）之间的关联。平均+/-SD 血浆神经鞘磷脂水平为 48.0+/-16.0mg/dL。在 5 年的随访期间，共有 189 例患者发生了经裁定的 CHD 事件。在 Kaplan-Meier 分析中，血浆神经鞘磷脂水平高于性别特异性中位数的患者与血浆神经鞘磷脂水平等于或低于性别特异性中位数的患者的无事件生存曲线相似（97.16%比 97.00%；对数秩 P=0.71）。在单变量 Cox 比例风险分析中，血浆神经鞘磷脂水平不是新发 CHD 事件的预测因子（风险比，0.992[0.982-1.004]；P=0.09）。在我们的多阶段多变量 Cox 比例风险模型中，当将总胆固醇、高密度脂蛋白和甘油三酯纳入模型时，较高的血浆神经鞘磷脂水平与新发 CHD 事件呈适度的负相关（风险比，0.985[0.973-0.996]；P=0.008），并且在调整年龄、性别、总胆固醇、高密度脂蛋白、甘油三酯、糖尿病、吸烟、收缩压和舒张压、血压药物治疗以及 3-羟基-3-甲基戊二酰辅酶 A 还原酶抑制剂的使用后，在我们的全模型中也是如此（风险比，0.984[0.973-0.996]；P=0.002）。在其他模型中，血浆神经鞘磷脂水平与新发 CHD 事件无关。
在无基线临床心血管疾病的人群中，较高的血浆神经鞘磷脂水平与新发 CHD 的风险增加无关。
