Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
Department of Radiology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
Neuroimage Clin. 2023;39:103502. doi: 10.1016/j.nicl.2023.103502. Epub 2023 Aug 22.
Current evidence suggests a potential association between cerebral microbleeds (CMBs), low-density lipoprotein cholesterol (LDL-C) levels, and statin use, but the exact relationship remains unclear. This study aims to prospectively examine these relationships in a stroke-free population.
From January 2010 to January 2020, we enrolled stroke-free individuals with at least one cerebral small vessel disease imaging marker from the CIRCLE study (ClinicalTrials.gov ID: NCT03542734). Participants underwent baseline and 1-year follow-up susceptibility-weighted imaging (SWI), and baseline LDL-C testing. New CMBs were categorized as strictly lobar and deep CMBs based on location.
A total of 209 individuals were included. Baseline serum LDL-C levels were divided into quartiles: Q1 (≤1.76 mmol/L), Q2 (1.77-2.36 mmol/L), Q3 (2.37-2.93 mmol/L), and Q4 (>2.93 mmol/L). The incidence of new deep CMBs was 30.0%, 11.1%, 10.9%, 8.2% in Q1, Q2, Q3, Q4, respectively. Multivariate logistic model revealed that only LDL-C in Q1 was associated with increased incidence of new deep CMBs (OR = 4.256; 95% CI: 1.156-15.666; p = 0.029). In a subset of 169 participants without prior statin use, the use of atorvastatin was associated with reduced occurrence of new deep CMBs (OR = 0.181; 95% CI: 0.035-0.928; p = 0.040), while it was not found with rosuvastatin (OR = 0.808; 95% CI: 0.174-3.741; p = 0.785).
While lower LDL-C levels were associated with higher CMB development, statin therapy did not increase the risk of new CMBs. Atorvastatin even demonstrated a protective effect.
目前的证据表明，脑微出血（CMB）、低密度脂蛋白胆固醇（LDL-C）水平和他汀类药物的使用之间存在潜在关联，但确切的关系尚不清楚。本研究旨在前瞻性地在无卒中人群中研究这些关系。
本研究纳入了来自 CIRCLE 研究（ClinicalTrials.gov 注册号：NCT03542734）的无卒中且至少存在一个脑小血管疾病影像学标志物的个体。参与者接受基线和 1 年的磁共振磁敏感加权成像（SWI）随访，以及基线 LDL-C 检测。新的 CMB 根据位置分为严格的皮质下和深部 CMB。
共纳入 209 名参与者。将基线血清 LDL-C 水平分为四分位数：Q1（≤1.76mmol/L）、Q2（1.77-2.36mmol/L）、Q3（2.37-2.93mmol/L）和 Q4（>2.93mmol/L）。Q1、Q2、Q3 和 Q4 组新深部 CMB 的发生率分别为 30.0%、11.1%、10.9%和 8.2%。多变量逻辑模型显示，只有 Q1 组 LDL-C 与新深部 CMB 发生率增加相关（OR=4.256；95%CI：1.156-15.666；p=0.029）。在没有他汀类药物使用史的 169 名参与者的亚组中，阿托伐他汀的使用与新深部 CMB 的发生减少相关（OR=0.181；95%CI：0.035-0.928；p=0.040），而瑞舒伐他汀则没有（OR=0.808；95%CI：0.174-3.741；p=0.785）。
虽然较低的 LDL-C 水平与较高的 CMB 发展相关，但他汀类药物治疗并未增加新 CMB 的风险。阿托伐他汀甚至显示出保护作用。
