Saber Hamidreza, Himali Jayandra J, Shoamanesh Ashkan, Beiser Alexa, Pikula Aleksandra, Harris Tamara B, Roubenoff Ronenn, Romero Jose Rafael, Kase Carlos S, Vasan Ramachandran S, Seshadri Sudha
From the Framingham Heart Study, MA (H.S., A.B., J.R.R., C.S.K., R.S.V., S.S.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Division of Neurology, Department of Medicine, McMaster University/Population Health Research Institute, Hamilton, ON, Canada (A.S.); Department of Neurology, University of Toronto, Toronto, ON, Canada (A.P.); Geriatric Epidemiology section, National Institute on Aging, National Institute of Health, Bethesda, MD (T.B.H.); Friedman School of Nutrition Science and Policy, Tufts University School of Medicine, Boston, MA (R.R.); and Department of Neurology, Boston University School of Medicine, MA (H.S., J.J.H., A.B., J.R.R., C.S.K., R.S.V., S.S.).
Stroke. 2015 Oct;46(10):2881-5. doi: 10.1161/STROKEAHA.115.009463. Epub 2015 Sep 3.
Leptin is a major adipokine that regulates weight balance and energy homeostasis. There is inconsistent evidence linking circulating leptin levels to risk of stroke. We tested the hypothesis that leptin levels are associated with risk of incident stroke in an elderly community based sample.
Serum leptin levels were assayed in 757 stroke free individuals (mean age, 79 years; 62% women) from the Framingham Original Cohort at the 22nd examination cycle (1990-1994). Incidence of all -stroke and ischemic stroke were prospectively ascertained.
During a mean follow up of 10 years, 119 individuals developed stroke (99 ischemic strokes). In multivariable Cox regression models, log leptin levels were not associated with incidence of all -stroke or ischemic stroke (hazard ratios per SD increment in log leptin 0.90 [0.73-1.09] and 0.89 [0.72-1.11], respectively). The results were suggestive for potential effect modification by waist/hip ratio for the association between leptin and stroke (P=0.03). Adjusting for age, sex, and established stroke risk factors, analysis stratified by waist/hip ratio quartiles revealed a lower incidence of first-ever all-stroke and ischemic stroke associated with higher leptin levels among only subjects in the top waist/hip ratio quartile (hazard ratio, 0.64 [0.43, 0.95] versus 0.98 [0.77, 1.25] for incident all-stroke and 0.61 [0.39, 0.95] versus 0.96 [0.74, 1.26] for ischemic stroke).
Leptin levels were not directly related to the risk of incident stroke overall but there was an inverse association with stroke in the top waist/hip ratio quartile. Further investigations are required to confirm these findings and explore possible mechanisms for the observed association.
瘦素是一种主要的脂肪因子，可调节体重平衡和能量稳态。关于循环瘦素水平与中风风险之间的联系，证据并不一致。我们检验了这样一个假设：在一个基于社区的老年样本中，瘦素水平与首次发生中风的风险相关。
在第22个检查周期（1990 - 1994年），对来自弗雷明汉原始队列的757名无中风个体（平均年龄79岁；62%为女性）测定血清瘦素水平。前瞻性确定所有中风和缺血性中风的发病率。
在平均10年的随访期间，119人发生中风（99例缺血性中风）。在多变量Cox回归模型中，瘦素水平的对数与所有中风或缺血性中风的发病率无关（瘦素水平对数每增加一个标准差，风险比分别为0.90 [0.73 - 1.09]和0.89 [0.72 - 1.11]）。结果提示腰臀比可能对瘦素与中风之间的关联产生效应修正作用（P = 0.03）。在调整年龄、性别和已确定的中风风险因素后，按腰臀比四分位数分层分析显示，仅在腰臀比最高的四分位数组中，较高的瘦素水平与首次发生所有中风和缺血性中风的较低发病率相关（所有中风的风险比为0.64 [0.43, 0.95]，而发病的所有中风为0.98 [0.77, 1.25]；缺血性中风的风险比为0.61 [0.39, 0.95]，而发病的缺血性中风为0.96 [0.74, 1.26]）。
总体而言，瘦素水平与首次发生中风的风险无直接关系，但在腰臀比最高的四分位数组中，瘦素与中风呈负相关。需要进一步研究来证实这些发现，并探索观察到的关联的可能机制。
