Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters Veterans Affairs Medical Center, Research & Development, Bronx, NY, USA.
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Alzheimers Dement. 2018 Jul;14(7):952-960. doi: 10.1016/j.jalz.2018.01.009. Epub 2018 Mar 5.
Some associations of high total cholesterol with dementia risk diminish as the outcome age-age at cognitive assessment-increases.
The Framingham Heart Study provided 1897 participants with intact cognition at entry. Cox regression analysis for incident marked cognitive decline included "time-dependent" coefficients, with associations between total cholesterol and covariates changing by outcome age. Decline within age categories of 75-84 and 85-94 years was also examined.
Significant associations of rising total cholesterol linear slope, low entry age, low education, and statin nonuse with risk diminished significantly by outcome age. At 85-94 years, falling linear slope was significant.
The protected survival model posits a minority subpopulation with protection against mortality and cognitive decline associated with total cholesterol risk factors. It predicts the observed diminished or reversed cholesterol associations with increasing age. Protection is particularly likely for successful cognitive aging-intact cognition at very old age-despite increased risk from cholesterol.
随着认知评估时的年龄（即结局年龄）增加，总胆固醇水平与痴呆风险之间的一些关联会减弱。
弗雷明汉心脏研究纳入了 1897 名认知功能完整的参与者。发生明显认知衰退的 Cox 回归分析包括“时变”系数，总胆固醇与协变量之间的关联随结局年龄而变化。还检查了 75-84 岁和 85-94 岁年龄组内的衰退情况。
随着总胆固醇线性斜率升高、起始年龄低、受教育程度低和不使用他汀类药物，与风险相关的显著关联显著随结局年龄而减弱。在 85-94 岁时，线性斜率下降具有显著意义。
保护生存模型假设存在一个少数亚人群，他们对与总胆固醇风险因素相关的死亡率和认知衰退具有保护作用。它预测了随着年龄的增长，胆固醇与痴呆风险之间的关联会减弱或逆转。尽管胆固醇风险增加，但保护作用特别可能存在于成功的认知老化（即使在非常高龄时认知功能仍完整）中。
