From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD.
Neurology. 2019 May 28;92(22):e2580-e2593. doi: 10.1212/WNL.0000000000007574. Epub 2019 May 1.
To examine the association of specific lipoproteins/inflammatory enzyme with cognitive change.
We examined the association of apolipoprotein B (ApoB), small-dense low-density lipoprotein cholesterol (sdLDL-C), lipoprotein (a) (Lp[a]), and lipoprotein-associated phospholipase A (LpPLA) activity with 15-year change in Delayed Word Recall Test, Digit Symbol Substitution Test (DSST), Word Fluency Test (WFT), and overall summary score in 9,350 participants in the Atherosclerosis Risk in Communities study. We assessed interaction by race, sex, education, ε4 status, and statin use. We also addressed questions of informative missingness, the role of stroke, and the influence of fasting status.
The mean (SD) age was 63.4 (5.7) years; 56.4% were women and 17.4% were black. We observed faster cognitive decline on DSST and global scores with every 10-mg/dL higher sdLDL-C level (Δ DSST score, -0.010; 95% confidence interval [CI] -0.017, -0.002 and Δ global score, -0.011; -0.021, -0.001) and the highest vs the lowest ApoB quintiles (Δ DSST score, -0.092; -0.0164, -0.019 and Δ global score, -0.101; -0.200, -0.002). Association for the ApoB quintiles with Δ global score (-0.10) was comparable with that of having 1 ε4 allele (-0.11). Higher Lp(a) was associated with slower decline in DSST, WFT, and global scores. LpPLA activity was not associated with cognitive change. Results were similar in sensitivity analyses. The associations of sdLDL-C or Lp(a) on cognitive change were more pronounced in statin users.
Optimal control of atherogenic lipoproteins such as ApoB and sdLDL-C in midlife for cardiovascular health may also benefit late-life cognitive health.
探讨特定脂蛋白/炎症酶与认知变化的关系。
我们研究了载脂蛋白 B (ApoB)、小而密低密度脂蛋白胆固醇 (sdLDL-C)、脂蛋白(a) (Lp[a])和脂蛋白相关磷脂酶 A (LpPLA)活性与动脉粥样硬化风险社区研究 9350 名参与者 15 年延迟单词回忆测试、数字符号替代测试 (DSST)、单词流畅性测试 (WFT)和总综合评分变化之间的关系。我们通过种族、性别、教育程度、ε4 状态和他汀类药物使用情况评估了相互作用。我们还解决了信息缺失、中风作用和空腹状态的影响问题。
参与者的平均（SD）年龄为 63.4（5.7）岁，56.4%为女性，17.4%为黑人。我们观察到，随着 sdLDL-C 水平每增加 10mg/dL，DSST 和全球评分的认知下降速度加快（DSST 评分的变化，-0.010；95%置信区间 [CI] -0.017，-0.002 和全球评分的变化，-0.011；-0.021，-0.001），以及 ApoB 五分位数的最高值与最低值之间（DSST 评分的变化，-0.092；-0.0164，-0.019 和全球评分的变化，-0.101；-0.200，-0.002）。ApoB 五分位数与 Δ 全球评分（-0.10）的关联与携带 1 个 ε4 等位基因（-0.11）相当。较高的 Lp(a)与 DSST、WFT 和全球评分下降较慢相关。LpPLA 活性与认知变化无关。敏感性分析结果相似。他汀类药物使用者的 sdLDL-C 或 Lp(a)对认知变化的影响更为显著。
中年控制动脉粥样硬化脂蛋白，如 ApoB 和 sdLDL-C，对心血管健康有益，也可能有益于晚年认知健康。
