Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
Prostate. 2023 Aug;83(11):1046-1059. doi: 10.1002/pros.24546. Epub 2023 May 8.
Cholesterol reduction is considered a mechanism through which cholesterol-lowering drugs including statins are associated with a reduced aggressive prostate cancer risk. While prior cohort studies found positive associations between total cholesterol and more advanced stage and grade in White men, whether associations for total cholesterol, low (LDL)- and high (HDL)-density lipoprotein cholesterol, apolipoprotein B (LDL particle) and A1 (HDL particle), and triglycerides are similar for fatal prostate cancer and in Black men, who experience a disproportionate burden of total and fatal prostate cancer, is unknown.
We conducted a prospective study of 1553 Black and 5071 White cancer-free men attending visit 1 (1987-1989) of the Atherosclerosis Risk in Communities Study. A total of 885 incident prostate cancer cases were ascertained through 2015, and 128 prostate cancer deaths through 2018. We estimated multivariable-adjusted hazard ratios (HRs) of total and fatal prostate cancer per 1-standard deviation increments and for tertiles (T1-T3) of time-updated lipid biomarkers overall and in Black and White men.
Greater total cholesterol concentration (HR per-1 SD = 1.25; 95% CI = 1.00-1.58) and LDL cholesterol (HR per-1 SD = 1.26; 95% CI = 0.99-1.60) were associated with higher fatal prostate cancer risk in White men only. Apolipoprotein B was nonlinearly associated with fatal prostate cancer overall (T2 vs. T1: HR = 1.66; 95% CI = 1.05-2.64) and in Black men (HR = 3.59; 95% CI = 1.53-8.40) but not White men (HR = 1.13; 95% CI = 0.65-1.97). Tests for interaction by race were not statistically significant.
These findings may improve the understanding of lipid metabolism in prostate carcinogenesis by disease aggressiveness, and by race while emphasizing the importance of cholesterol control.
降低胆固醇被认为是降低胆固醇药物（包括他汀类药物）与降低侵袭性前列腺癌风险相关的机制。虽然先前的队列研究发现总胆固醇与白人男性更晚期和更高级别的前列腺癌之间存在正相关，但总胆固醇、低（LDL）-和高密度（HDL）-脂蛋白胆固醇、载脂蛋白 B（LDL 颗粒）和 A1（HDL 颗粒）以及甘油三酯与致命性前列腺癌的相关性是否相似，以及在黑人男性中，他们承受着总前列腺癌和致命性前列腺癌不成比例的负担，目前尚不清楚。
我们对参加社区动脉粥样硬化风险研究（Atherosclerosis Risk in Communities Study）第 1 次就诊（1987-1989 年）的 1553 名黑人男性和 5071 名白人男性进行了一项前瞻性研究。通过 2015 年确定了 885 例新发前列腺癌病例，通过 2018 年确定了 128 例前列腺癌死亡病例。我们估计了总胆固醇和致命性前列腺癌的多变量调整后危险比（HR），每增加 1 个标准差，以及根据脂质生物标志物的时间更新的三分位数（T1-T3），总体以及黑人男性和白人男性的情况。
总胆固醇浓度越高（每增加 1 个 SD 的 HR = 1.25；95%CI = 1.00-1.58）和 LDL 胆固醇（每增加 1 个 SD 的 HR = 1.26；95%CI = 0.99-1.60）与白人男性的致命性前列腺癌风险增加相关。载脂蛋白 B 与总致命性前列腺癌呈非线性相关（T2 与 T1：HR = 1.66；95%CI = 1.05-2.64），与黑人男性（HR = 3.59；95%CI = 1.53-8.40）和白人男性（HR = 1.13；95%CI = 0.65-1.97）也相关。按种族进行的交互检验不具有统计学意义。
这些发现可能通过疾病侵袭性和种族来提高对前列腺癌发生过程中脂代谢的理解，同时强调了控制胆固醇的重要性。
