Vascular Biology Unit, James Cook University School of Medicine, Townsville, Queensland, Australia.
Am J Cardiol. 2010 May 15;105(10):1480-4. doi: 10.1016/j.amjcard.2009.12.076. Epub 2010 Mar 30.
The importance of dyslipidemia in the etiology of abdominal aortic aneurysm (AAA) is poorly defined, in part because previous association analyses have often not considered the use of current lipid-modifying medications. Medications targeted at altering the concentrations of circulating lipids have an established role in occlusive atherosclerosis but are of unknown value in the primary prevention of AAA. We examined the association between fasting serum levels of triglycerides low- and high-density lipoprotein and the presence of an AAA in a cohort of 3,327 men aged 65 to 83 years. The analyses were adjusted for established risk factors of AAA and the prescription of lipid-modifying agents using multiple logistic regression analysis. Of the 3,327 men, 1,043 (31%) were receiving lipid-modifying therapy at the fasting lipid measurement. The lipid-modifying therapy was statins in most cases (n = 1,023). The serum high-density lipoprotein concentrations were lower in patients with AAAs. The serum high-density lipoprotein concentration was independently associated with a reduced risk of having an AAA in men not receiving current lipid-modifying therapy (odds ratio 0.72, 95% confidence interval 0.56 to 0.93 per 0.4-mM increase) and in the total cohort (odds ratio 0.76, 95% confidence interval 0.63 to 0.91 per 0.4-mM increase, adjusted for lipid-modifying therapy). The concentrations of low-density lipoprotein and triglycerides were not associated with the presence of AAAs. In conclusion, high-density lipoprotein appeared to be the most important lipid in predicting the risk of AAA development, with potential value as a therapeutic target. Current cardiovascular strategies aimed at lowering low-density lipoprotein might not have any effect on the prevention of AAAs.
载脂蛋白代谢异常在腹主动脉瘤（AAA）发病机制中的重要性尚未明确，部分原因在于之前的关联分析通常未考虑当前调脂药物的使用情况。靶向改变循环脂质浓度的药物在闭塞性动脉粥样硬化中具有明确的作用，但在 AAA 的一级预防中价值未知。我们在一个 65 至 83 岁的 3327 名男性队列中，研究了空腹血清甘油三酯和高低密度脂蛋白与 AAA 存在之间的关联。使用多因素逻辑回归分析，对 AAA 的既定危险因素和调脂药物的处方进行了调整。在 3327 名男性中，1043 名（31%）在空腹血脂检测时正在接受调脂治疗。在大多数情况下，调脂治疗是他汀类药物（n=1023）。与 AAA 患者相比，血清高密度脂蛋白浓度较低。在未接受当前调脂治疗的男性中，血清高密度脂蛋白浓度与 AAA 发生风险降低独立相关（比值比 0.72，95%置信区间 0.56 至 0.93，每增加 0.4mmol/L），在总队列中也是如此（比值比 0.76，95%置信区间 0.63 至 0.91，调整调脂治疗后）。低密度脂蛋白和甘油三酯浓度与 AAA 的发生无关。总之，高密度脂蛋白似乎是预测 AAA 发展风险的最重要脂质，具有作为治疗靶点的潜在价值。旨在降低低密度脂蛋白的当前心血管策略可能对预防 AAA 没有任何作用。
