University of Alabama at Birmingham, Birmingham, AL, USA.
Kaiser Permanente Division of Research, Oakland, CA, USA.
J Int Neuropsychol Soc. 2021 Nov;27(10):1048-1057. doi: 10.1017/S1355617721000059. Epub 2021 Feb 10.
It is uncertain if long-term levels of low-density lipoprotein-cholesterol (LDL-C) affect cognition in middle age. We examined the association of LDL-C levels over 25 years with cognitive function in a prospective cohort of black and white US adults.
Lipids were measured at baseline (1985-1986; age: 18-30 years) and at serial examinations conducted over 25 years. Time-averaged cumulative LDL-C was calculated using the area under the curve for 3,328 participants with ≥3 LDL-C measurements and a cognitive function assessment. Cognitive function was assessed at the Year 25 examination with the Digit Symbol Substitution Test [DSST], Rey Auditory Visual Learning Test [RAVLT], and Stroop Test. A brain magnetic resonance imaging (MRI) sub-study (N = 707) was also completed at Year 25 to assess abnormal white matter tissue volume (AWMV) and gray matter cerebral blood flow volume (GM-CBFV) as secondary outcomes.
There were 15.6%, 32.9%, 28.9%, and 22.6% participants with time-averaged cumulative LDL-C <100 mg/dL, 101-129 mg/dL, 130-159 mg/dL, and ≥160 mg/dL, respectively. Standardized differences in all cognitive function test scores ranged from 0.16 SD lower to 0.09 SD higher across time-averaged LDL-C categories in comparison to those with LDL-C < 100 mg/dL. After covariate adjustment, participants with higher versus lower time-averaged LDL-C had a lower RAVLT score (p-trend = 0.02) but no differences were present for DSST, Stroop Test, AWMV, or GM-CBFV.
Cumulative LDL-C was associated with small differences in memory, as assessed by RAVLT scores, but not other cognitive or brain MRI measures over 25 years of follow-up.
目前尚不确定 LDL-胆固醇（LDL-C）的长期水平是否会影响中年人的认知能力。我们在一项由美国黑人和白人成年人组成的前瞻性队列中，研究了 25 年内 LDL-C 水平与认知功能的关系。
在基线（1985-1986 年；年龄：18-30 岁）和 25 年内进行的多次检查中测量了脂质。使用 3,328 名至少有 3 次 LDL-C 测量和认知功能评估的参与者的曲线下面积，计算了时间平均累积 LDL-C。在第 25 年的检查中使用数字符号替代测试（DSST）、 Rey 听觉视觉学习测试（RAVLT）和 Stroop 测试评估认知功能。还在第 25 年完成了脑磁共振成像（MRI）子研究（N=707），以评估异常白质组织体积（AWMV）和灰质脑血流体积（GM-CBFV）作为次要结果。
时间平均累积 LDL-C<100mg/dL、101-129mg/dL、130-159mg/dL 和≥160mg/dL 的参与者分别占 15.6%、32.9%、28.9%和 22.6%。与 LDL-C<100mg/dL 相比，所有认知功能测试评分的标准化差异在时间平均 LDL-C 类别中分别低 0.16 个标准差到高 0.09 个标准差。在调整协变量后，与较低的时间平均 LDL-C 相比，较高的时间平均 LDL-C 的参与者的 RAVLT 评分较低（趋势 P=0.02），但 DSST、Stroop 测试、AWMV 或 GM-CBFV 无差异。
在 25 年的随访中，累积 LDL-C 与 RAVLT 评分评估的记忆差异相关，但与其他认知或脑 MRI 测量无关。
