曼哈顿北部研究中的血脂谱成分与亚临床脑血管疾病
Lipid profile components and subclinical cerebrovascular disease in the northern Manhattan study.
作者信息
Willey Joshua Z, Gardener Hannah, Moon Yeseon P, Yoshita Mitsuhiro, DeCarli Charles, Cheung Ying Kuen, Sacco Ralph L, Elkind Mitchell S V, Wright Clinton B
机构信息
Department of Neurology, Columbia University, New York, N.Y., USA.
出版信息
Cerebrovasc Dis. 2014;37(6):423-30. doi: 10.1159/000362920. Epub 2014 Jul 12.
BACKGROUND
Subclinical cerebrovascular disease has been associated with multiple adverse events related to aging, including stroke and dementia. The modifiable risk factors for subclinical cerebrovascular disease beyond hypertension have not been well characterized. Our objective was to examine the association between baseline, and changes over time, in lipid profile components and subclinical cerebrovascular disease on magnetic resonance imaging (MRI).
METHODS
Fasting plasma lipids were collected on participants in the Northern Manhattan Study, a prospective cohort study examining risk factors for cardiovascular disease in a multiethnic elderly urban-dwelling population. A subsample of the cohort underwent brain MRI between 2003 and 2008 (a median of 6.2 years, range = 0-14, after enrollment), when repeat fasting lipids were obtained. We used lipid profile components at the time of initial enrollment (n = 1,256 with lipids available) as categorical variables, as well as change in clinical categories over the two measures (n = 1,029). The main outcome measures were (1) total white matter hyperintensity volume (WMHV) using linear regression and (2) silent brain infarcts (SBI) using logistic regression.
RESULTS
None of the plasma lipid profile components at the time of enrollment were associated with WMHV. The association between baseline lipids and WMHV was, however, modified by apolipoprotein E (apoE) status (χ(2) with 2 degrees of freedom, p = 0.03), such that among apoE4 carriers those with total cholesterol (TC) ≥200 mg/dl had a trend towards smaller WMHV than those with TC <200 mg/dl (difference in logWMHV -0.19, p = 0.07), while there was no difference among apoE3 carriers. When examining the association between WMHV and change in lipid profile components we noted an association with change in high-density lipoprotein cholesterol (HDL-C, >50 mg/dl for women, >40 mg/dl for men) and TC. A transition from low-risk HDL-C (>50 mg/dl for women, >40 mg/dl for men) at baseline to high-risk HDL-C at the time of MRI (vs. starting and remaining low risk) was associated with greater WMHV (difference in logWMHV 0.34, p value 0.03). We noted a similar association with transitioning to a TC ≥200 mg/dl at the time of MRI (difference in logWMHV 0.25, p value 0.006). There were no associations with baseline or change in lipid profile components with SBI.
CONCLUSIONS
The association of plasma lipid profile components with greater WMHV may depend on apoE genotype and worsening HDL and TC risk levels over time.
背景
亚临床脑血管疾病与多种衰老相关的不良事件有关，包括中风和痴呆。除高血压外，亚临床脑血管疾病的可改变危险因素尚未得到充分描述。我们的目的是研究磁共振成像（MRI）上血脂谱成分的基线水平及其随时间的变化与亚临床脑血管疾病之间的关联。
方法
在北曼哈顿研究中收集参与者的空腹血脂，该研究是一项前瞻性队列研究，旨在调查多民族老年城市居民心血管疾病的危险因素。该队列的一个子样本在2003年至2008年期间（入组后中位数为6.2年，范围 = 0 - 14年）接受了脑部MRI检查，同时获取了重复的空腹血脂。我们将初始入组时（n = 1256，有可用血脂数据）的血脂谱成分作为分类变量，以及两次测量之间临床类别变化（n = 1029）。主要结局指标为：（1）使用线性回归分析总白质高信号体积（WMHV）；（2）使用逻辑回归分析无症状脑梗死（SBI）。
结果
入组时血浆血脂谱成分均与WMHV无关。然而，载脂蛋白E（apoE）状态改变了基线血脂与WMHV之间的关联（自由度为2的χ(2)检验，p = 0.03），即apoE4携带者中，总胆固醇（TC）≥200 mg/dl者的WMHV有低于TC <200 mg/dl者的趋势（logWMHV差值为 -0.19，p = 0.07），而apoE3携带者之间无差异。在研究WMHV与血脂谱成分变化之间的关联时，我们发现其与高密度脂蛋白胆固醇（HDL-C，女性>50 mg/dl，男性>40 mg/dl）和TC的变化有关。从基线时的低风险HDL-C（女性>50 mg/dl，男性>40 mg/dl）转变为MRI检查时的高风险HDL-C（与起始并保持低风险相比）与更大的WMHV相关（logWMHV差值为0.34，p值为0.03）。我们发现向MRI检查时TC≥200 mg/dl转变也有类似关联（logWMHV差值为0.25，p值为0.006）。血脂谱成分的基线水平或变化与SBI均无关联。
结论
血浆血脂谱成分与更大的WMHV之间的关联可能取决于apoE基因型以及HDL和TC风险水平随时间的恶化情况。
Zotero 插件