Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel.
Mov Disord. 2018 Aug;33(8):1298-1305. doi: 10.1002/mds.27413. Epub 2018 Aug 25.
Higher levels of serum cholesterol are well-established risk factors for coronary artery disease and stroke. The role of serum cholesterol in neurodegeneration is not clear.
We evaluated the association between serum cholesterol levels over time and the risk of Parkinson's disease (PD) among statin-free individuals.
A population-based cohort study of 261,638 statin-free individuals (aged 40-79 years at their first serum cholesterol test, 42.7% men), with repeated measures of total, low, and high-density lipoprotein cholesterol was performed from 1999 to 2012. Individuals were followed from their first cholesterol test until PD incidence, death, or end of study. The PD incidence was assessed using a validated antiparkinsonian-drug tracing approach. Cox models stratified by sex and age with time-dependent cholesterol variables were applied to estimate PD hazard ratios.
A total of 764 (3.3% patients aged 65 + years) incident PD cases were detected during a mean follow-up of 7.9 (±3.6) years. Among men, the middle and upper tertiles of total and low-density lipoprotein cholesterol compared to the lowest were significantly associated with a lower PD risk. Age-pooled hazard ratios (95% confidence interval) for middle and upper tertiles were 0.82 (0.66-1.01) and 0.71 (0.55-0.93), respectively, for total cholesterol, and 0.80 (0.65-0.98) and 0.72 (0.54-0.95) respectively, for low-density lipoprotein cholesterol. Among women, the association between total and low-density lipoprotein cholesterol levels with PD risk was not significant. Null results were found for both sexes for high-density lipoprotein cholesterol.
Higher levels of total and low-density lipoprotein cholesterol among men over time indicated a decreased PD risk. The potential role of cholesterol in disease protection warrants further investigation. © 2018 International Parkinson and Movement Disorder Society.
血清胆固醇水平升高是冠心病和中风的明确危险因素。血清胆固醇在神经退行性变中的作用尚不清楚。
我们评估了他汀类药物治疗患者中，血清胆固醇水平随时间的变化与帕金森病（PD）风险之间的关系。
我们开展了一项基于人群的队列研究，共纳入 261638 例未使用他汀类药物的个体（首次血清胆固醇检测时年龄为 40-79 岁，42.7%为男性），从 1999 年至 2012 年进行了多次总胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇的测量。个体从首次胆固醇检测开始随访，直至 PD 发病、死亡或研究结束。通过验证的抗帕金森病药物追踪方法评估 PD 发病率。应用 Cox 模型（按性别和年龄分层，采用时间依赖性胆固醇变量）来估计 PD 风险比。
在平均 7.9（±3.6）年的随访期间，共发现 764 例（65 岁及以上患者 3.3%）新发 PD 病例。在男性中，总胆固醇和低密度脂蛋白胆固醇的中值和高值与最低值相比，PD 发病风险显著降低。总胆固醇中值和高值的年龄合并风险比（95%置信区间）分别为 0.82（0.66-1.01）和 0.71（0.55-0.93），低密度脂蛋白胆固醇中值和高值的风险比分别为 0.80（0.65-0.98）和 0.72（0.54-0.95）。在女性中，总胆固醇和低密度脂蛋白胆固醇水平与 PD 发病风险之间无显著关联。对于男女两性，高密度脂蛋白胆固醇均未发现显著关联。
男性随时间推移总胆固醇和低密度脂蛋白胆固醇水平升高与 PD 发病风险降低相关。胆固醇在疾病保护中的潜在作用值得进一步研究。
