中年时期主要心血管危险因素与痴呆症之间的性别差异：来自英国生物库的队列研究数据。
Sex differences in the association between major cardiovascular risk factors in midlife and dementia: a cohort study using data from the UK Biobank.
机构信息
The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW, 2042, Australia.
The George Institute for Global Health, Imperial College London, Central Working - Fourth Floor, Translation and Innovation Hub, Imperial College London, 80 Wood Lane, London, W12 0BZ, UK.
出版信息
BMC Med. 2021 May 19;19(1):110. doi: 10.1186/s12916-021-01980-z.
BACKGROUND
Sex differences in major cardiovascular risk factors for incident (fatal or non-fatal) all-cause dementia were assessed in the UK Biobank. The effects of these risk factors on all-cause dementia were explored by age and socioeconomic status (SES).
METHODS
Cox proportional hazards models were used to estimate hazard ratios (HRs) and women-to-men ratio of HRs (RHR) with 95% confidence intervals (CIs) for systolic blood pressure (SBP) and diastolic blood pressure (DBP), smoking, diabetes, adiposity, stroke, SES and lipids with dementia. Poisson regression was used to estimate the sex-specific incidence rate of dementia for these risk factors.
RESULTS
502,226 individuals in midlife (54.4% women, mean age 56.5 years) with no prevalent dementia were included in the analyses. Over 11.8 years (median), 4068 participants (45.9% women) developed dementia. The crude incidence rates were 5.88 [95% CI 5.62-6.16] for women and 8.42 [8.07-8.78] for men, per 10,000 person-years. Sex was associated with the risk of dementia, where the risk was lower in women than men (HR = 0.83 [0.77-0.89]). Current smoking, diabetes, high adiposity, prior stroke and low SES were associated with a greater risk of dementia, similarly in women and men. The relationship between blood pressure (BP) and dementia was U-shaped in men but had a dose-response relationship in women: the HR for SBP per 20 mmHg was 1.08 [1.02-1.13] in women and 0.98 [0.93-1.03] in men. This sex difference was not affected by the use of antihypertensive medication at baseline. The sex difference in the effect of raised BP was consistent for dementia subtypes (vascular dementia and Alzheimer's disease).
CONCLUSIONS
Several mid-life cardiovascular risk factors were associated with dementia similarly in women and men, but not raised BP. Future bespoke BP-lowering trials are necessary to understand its role in restricting cognitive decline and to clarify any sex difference.
背景
在英国生物银行中评估了主要心血管危险因素在新发（致命或非致命）全因痴呆方面的性别差异。通过年龄和社会经济地位（SES）探讨了这些危险因素对全因痴呆的影响。
方法
使用 Cox 比例风险模型估计收缩压（SBP）和舒张压（DBP）、吸烟、糖尿病、肥胖、中风、SES 和血脂与痴呆的风险比（HR）和女性与男性 HR 比（RHR），95%置信区间（CI）。泊松回归用于估计这些危险因素的痴呆特定发病率。
结果
纳入了 502226 名中年（54.4%女性，平均年龄 56.5 岁）无现有痴呆的个体。在 11.8 年（中位数）期间，有 4068 名参与者（45.9%女性）发生痴呆。女性的粗发病率为 5.88 [95%CI 5.62-6.16]，男性为 8.42 [8.07-8.78]，每 10000 人年。性别与痴呆风险相关，女性的风险低于男性（HR=0.83 [0.77-0.89]）。当前吸烟、糖尿病、肥胖、既往中风和低 SES 与痴呆风险增加相关，女性和男性情况相似。男性的血压（BP）与痴呆之间的关系呈 U 型，而女性呈剂量反应关系：SBP 每升高 20mmHg 的 HR 为 1.08 [1.02-1.13]，男性为 0.98 [0.93-1.03]。这种性别差异不受基线时使用降压药物的影响。升高的 BP 对痴呆亚型（血管性痴呆和阿尔茨海默病）的影响的性别差异是一致的。
结论
一些中年心血管危险因素对女性和男性的痴呆发生具有相似的相关性，但升高的 BP 则不然。未来需要进行专门的降压试验，以了解其在限制认知能力下降方面的作用，并阐明任何性别差异。
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