脂类、脂蛋白和代谢物与心肌梗死和中风的风险。
Lipids, Lipoproteins, and Metabolites and Risk of Myocardial Infarction and Stroke.
机构信息
Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, United Kingdom.
Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
出版信息
J Am Coll Cardiol. 2018 Feb 13;71(6):620-632. doi: 10.1016/j.jacc.2017.12.006.
BACKGROUND
Blood lipids are established risk factors for myocardial infarction (MI), but uncertainty persists about the relevance of lipids, lipoprotein particles, and circulating metabolites for MI and stroke subtypes.
OBJECTIVES
This study sought to investigate the associations of plasma metabolic markers with risks of incident MI, ischemic stroke (IS), and intracerebral hemorrhage (ICH).
METHODS
In a nested case-control study (912 MI, 1,146 IS, and 1,138 ICH cases, and 1,466 common control subjects) 30 to 79 years of age in China Kadoorie Biobank, nuclear magnetic resonance spectroscopy measured 225 metabolic markers in baseline plasma samples. Logistic regression was used to estimate adjusted odds ratios (ORs) for a 1-SD higher metabolic marker.
RESULTS
Very low-, intermediate-, and low-density lipoprotein particles were positively associated with MI and IS. High-density lipoprotein (HDL) particles were inversely associated with MI apart from small HDL. In contrast, no lipoprotein particles were associated with ICH. Cholesterol in large HDL was inversely associated with MI and IS (OR: 0.79 and 0.88, respectively), whereas cholesterol in small HDL was not (OR: 0.99 and 1.06, respectively). Triglycerides within all lipoproteins, including most HDL particles, were positively associated with MI, with a similar pattern for IS. Glycoprotein acetyls, ketone bodies, glucose, and docosahexaenoic acid were associated with all 3 diseases. The 225 metabolic markers showed concordant associations between MI and IS, but not with ICH.
CONCLUSIONS
Lipoproteins and lipids showed similar associations with MI and IS, but not with ICH. Within HDL particles, cholesterol concentrations were inversely associated, whereas triglyceride concentrations were positively associated with MI. Glycoprotein acetyls and several non-lipid-related metabolites associated with all 3 diseases.
背景
血脂是心肌梗死（MI）的既定危险因素，但血脂、脂蛋白颗粒和循环代谢产物与 MI 和中风亚型的相关性仍存在不确定性。
目的
本研究旨在探讨血浆代谢标志物与新发 MI、缺血性中风（IS）和脑出血（ICH）风险的相关性。
方法
在中国科克比生物银行的一项巢式病例对照研究中（912 例 MI、1146 例 IS 和 1138 例 ICH 病例，以及 1466 例普通对照受试者），对 30 至 79 岁的人群进行了基线血浆样本的核磁共振波谱检测，共测量了 225 种代谢标志物。使用逻辑回归估计代谢标志物每增加一个标准差（SD）的校正比值比（OR）。
结果
极低密度、中密度和低密度脂蛋白颗粒与 MI 和 IS 呈正相关。高密度脂蛋白（HDL）颗粒与 MI 呈负相关，除了小 HDL 颗粒。相比之下，没有脂蛋白颗粒与 ICH 相关。大 HDL 中的胆固醇与 MI 和 IS 呈负相关（OR：0.79 和 0.88），而小 HDL 中的胆固醇则没有（OR：0.99 和 1.06）。所有脂蛋白中的甘油三酯，包括大多数 HDL 颗粒，与 MI 呈正相关，与 IS 呈相似的模式。糖蛋白乙酰、酮体、葡萄糖和二十二碳六烯酸与所有 3 种疾病均相关。225 种代谢标志物在 MI 和 IS 之间显示出一致的相关性，但与 ICH 没有相关性。
结论
脂蛋白和脂质与 MI 和 IS 具有相似的相关性，但与 ICH 无关。在 HDL 颗粒中，胆固醇浓度呈负相关，而甘油三酯浓度呈正相关与 MI 相关。糖蛋白乙酰和几种与所有 3 种疾病相关的非脂类代谢物。
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