Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
Ann Neurol. 2022 Sep;92(3):379-389. doi: 10.1002/ana.26425. Epub 2022 Jul 9.
Conflicting results have been reported on the association between lipids and risk of ischemic stroke. We tested the hypothesis that the burden of ischemic stroke attributable to either elevated apolipoprotein B (apoB) or non-high-density lipoprotein (non-HDL) cholesterol is higher than that attributable to elevated low-density lipoprotein (LDL) cholesterol.
We included 104,618 individuals from an ongoing cohort study, the Copenhagen General Population Study. The associations of quintiles of apoB, non-HDL cholesterol, and LDL cholesterol with risk of ischemic stroke were estimated by Cox proportional hazards regressions with 95% confidence intervals. With 1 quintile as reference, the proportion of ischemic stroke attributable to the 2 , 3 , 4 , and 5 quintiles of apoB, non-HDL cholesterol, and LDL cholesterol were estimated by population attributable fractions.
Higher quintiles of apoB and non-HDL cholesterol were associated with increased risk of ischemic stroke (both trends: p < 0.0001), whereas for LDL cholesterol this association was somewhat attenuated (trend: p = 0.0005). A similar pattern was seen for population attributable fraction values. Compared to individuals in the 1 quintile, the combined proportion of ischemic stroke attributable to individuals in the 2 to 5 quintiles was 16.3% for apoB (levels >82 mg/dL), 14.7% for non-HDL cholesterol (>3.0 mmol/L; >117 mg/dL), and 6.8% for LDL cholesterol (>2.4 mmol/L; >94 mg/dL).
The proportion of ischemic stroke attributable to either elevated apoB or non-HDL cholesterol was double that attributable to elevated LDL cholesterol. ANN NEUROL 2022;92:379-389.
关于脂质与缺血性脑卒中风险之间的关系，已有相互矛盾的研究结果。我们检验了这样一个假设，即归因于载脂蛋白 B（apoB）或非高密度脂蛋白（non-HDL）胆固醇升高的缺血性脑卒中负担高于归因于低密度脂蛋白（LDL）胆固醇升高的负担。
我们纳入了正在进行的队列研究——哥本哈根普通人群研究中的 104618 名个体。采用 Cox 比例风险回归模型估计 apoB、非 HDL 胆固醇和 LDL 胆固醇五分位数与缺血性脑卒中风险的关联，置信区间为 95%。以 1 个五分位数为参照，通过人群归因分数估计 apoB、非 HDL 胆固醇和 LDL 胆固醇的 2、3、4 和 5 个五分位数与缺血性脑卒中的归因比例。
apoB 和非 HDL 胆固醇的五分位越高，缺血性脑卒中的风险越高（均呈趋势性，p<0.0001），而 LDL 胆固醇的这种相关性则有所减弱（趋势性，p=0.0005）。人群归因分数也呈现出类似的模式。与 1 个五分位数的个体相比，apoB（水平>82mg/dL）的 2 至 5 个五分位数的个体中，归因于缺血性脑卒中的综合比例为 16.3%，非 HDL 胆固醇（>3.0mmol/L；>117mg/dL）为 14.7%，LDL 胆固醇（>2.4mmol/L；>94mg/dL）为 6.8%。
归因于 apoB 或非 HDL 胆固醇升高的缺血性脑卒中比例是归因于 LDL 胆固醇升高的两倍。
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