Johns Hopkins University School of Medicine, Department of Psychiatry, Division of Geriatric Psychiatry and Behavioral Sciences, Bayview-Alpha Commons Building, 4 floor-Room 454, Baltimore, MD 21224, USA.
Neurology. 2010 Nov 23;75(21):1888-95. doi: 10.1212/WNL.0b013e3181feb2bf. Epub 2010 Nov 10.
Cellular and animal studies suggest that hypercholesterolemia contributes to Alzheimer disease (AD). However, the relationship between cholesterol and dementia at the population level is less clear and may vary over the lifespan.
The Prospective Population Study of Women, consisting of 1,462 women without dementia aged 38-60 years, was initiated in 1968-1969 in Gothenburg, Sweden. Follow-ups were conducted in 1974-1975, 1980-1981, 1992-1993, and 2000-2001. All-cause dementia was diagnosed according to DSM-III-R criteria and AD according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria. Cox proportional hazards regression examined baseline, time-dependent, and change in cholesterol levels in relation to incident dementia and AD among all participants. Analyses were repeated among participants who survived to the age of 70 years or older and participated in the 2000-2001 examination.
Higher cholesterol level in 1968 was not associated with an increased risk of AD (highest vs lowest quartile: hazard ratio [HR] 2.82, 95% confidence interval [CI] 0.94-8.43) among those who survived to and participated in the 2000-2001 examination. While there was no association between cholesterol level and dementia when considering all participants over 32 years, a time-dependent decrease in cholesterol over the follow-up was associated with an increased risk of dementia (HR 2.35, 95% CI 1.22-4.58).
These data suggest that midlife cholesterol level is not associated with an increased risk of AD. However, there may be a slight risk among those surviving to an age at risk for dementia. Declining cholesterol levels from midlife to late life may better predict AD risk than levels obtained at one timepoint prior to dementia onset. Analytic strategies examining this and other risk factors across the lifespan may affect interpretation of results.
细胞和动物研究表明，高胆固醇血症与阿尔茨海默病（AD）有关。然而，在人群水平上，胆固醇与痴呆症的关系尚不清楚，并且可能随寿命而变化。
1968-1969 年在瑞典哥德堡发起了一项名为“妇女前瞻性人群研究”的研究，该研究纳入了 1462 名年龄在 38-60 岁之间、无痴呆的女性。1974-1975 年、1980-1981 年、1992-1993 年和 2000-2001 年进行了随访。根据 DSM-III-R 标准诊断所有原因的痴呆症，根据国家神经病学、语言障碍和中风-阿尔茨海默氏病及相关疾病协会标准诊断 AD。Cox 比例风险回归分析了基线、随时间变化的胆固醇水平与所有参与者中发生的痴呆症和 AD 的关系。在所有活到 70 岁或以上并参加 2000-2001 年检查的参与者中重复了这些分析。
在参加 2000-2001 年检查的幸存者中，1968 年较高的胆固醇水平与 AD 风险增加无关（最高与最低四分位值：危险比[HR]2.82，95%置信区间[CI]0.94-8.43）。虽然在考虑所有 32 岁以上的参与者时，胆固醇水平与痴呆症之间没有关联，但随访期间胆固醇水平的下降与痴呆症的风险增加有关（HR 2.35，95%CI 1.22-4.58）。
这些数据表明，中年胆固醇水平与 AD 风险增加无关。然而，在存活到痴呆风险年龄的人群中，可能存在轻度风险。从中年到晚年的胆固醇水平下降可能比痴呆症发病前一个时间点的水平更好地预测 AD 风险。在整个生命周期中检查这种和其他风险因素的分析策略可能会影响对结果的解释。
