Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland; Department of Medical Didactics, Jagiellonian University Medical College, Krakow, Poland.
University Hospital, Krakow, Poland; Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Int J Cardiol. 2017 Oct 1;244:290-295. doi: 10.1016/j.ijcard.2017.06.076. Epub 2017 Jun 21.
High low-density lipoprotein (LDL)-cholesterol levels are a major cause of premature coronary heart disease (CHD) and death in patients with familial hypercholesterolemia (FH). It is uncertain whether these risk factors affect men and women equally. We aimed to compare the risk factors of carotid plaques, which are reliable surrogates of coronary atherosclerosis, in men and women with FH.
154 patients with FH (40.9% men) were included, diagnosed according to Simon Broome criteria. Carotid plaques were assessed by ultrasound.
In women multiple logistic regression analysis revealed that systolic blood pressure, high-density lipoprotein-cholesterol (HDL-C), apolipoprotein (apo) A1, and alanine aminotransferase (ALT) were associated with the presence of carotid plaques. In this female cohort, the age adjusted odds ratio for the increase of HDL-C by 1 standard deviation was related to a 55% decrease in the odds of having carotid plaques (p=0.01) and the age adjusted odds ratio for the increase of ALT by 1U/L was related to a 7% in the increase odds of having carotid plaques (p=0.02). In men, in multiple logistic regression analysis only apo B concentration was significantly related to carotid plaque presence. The odds ratio for the increase of apo B by 1mg/dl corresponded to a 4% increase in the odds of having carotid plaques (p=0.01) and, interestingly, in men not treated with statin, this ratio reached 8% (p=0.04).
In summary, our study suggests a difference in risk factors of carotid artery plaques between men and women with FH.
高低密度脂蛋白（LDL）-胆固醇水平是家族性高胆固醇血症（FH）患者早发冠心病（CHD）和死亡的主要原因。这些危险因素是否同样影响男性和女性尚不确定。我们旨在比较 FH 男性和女性颈动脉斑块的危险因素，颈动脉斑块是冠状动脉粥样硬化的可靠替代指标。
共纳入 154 例 FH 患者（40.9%为男性），根据 Simon Broome 标准进行诊断。通过超声评估颈动脉斑块。
在女性中，多变量逻辑回归分析显示，收缩压、高密度脂蛋白胆固醇（HDL-C）、载脂蛋白（apo）A1 和丙氨酸氨基转移酶（ALT）与颈动脉斑块的存在相关。在该女性队列中，HDL-C 增加 1 个标准差的校正后比值比与颈动脉斑块发生几率降低 55%相关（p=0.01），ALT 增加 1U/L 的校正后比值比与颈动脉斑块发生几率增加 7%相关（p=0.02）。在男性中，多元逻辑回归分析仅发现 apo B 浓度与颈动脉斑块的存在显著相关。apo B 增加 1mg/dl 的比值比与颈动脉斑块发生几率增加 4%相关（p=0.01），有趣的是，在未接受他汀类药物治疗的男性中，该比值增加到 8%（p=0.04）。
综上所述，我们的研究表明 FH 男性和女性颈动脉斑块的危险因素存在差异。
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