绝经过渡期的低密度脂蛋白亚类与冠状动脉钙化和颈动脉粥样硬化的风险：SWAN 心脏和 HDL 辅助研究。
Low-density lipoprotein subclasses over the menopausal transition and risk of coronary calcification and carotid atherosclerosis: the SWAN Heart and HDL ancillary studies.
机构信息
From the University of Pittsburgh, Pittsburgh, PA.
University of Massachusetts, Worcester, MA.
出版信息
Menopause. 2023 Oct 1;30(10):1006-1013. doi: 10.1097/GME.0000000000002245.
OBJECTIVE
Perimenopausal women experience a steep increase in low-density lipoprotein cholesterol (LDL-C) that is related to a higher risk of carotid plaque later in life. Low-density lipoprotein subclasses have been linked to cardiovascular diseases beyond LDL-C, promising a better risk stratification. We aim to characterize changes in LDL subclasses and assess their associations with presence of coronary artery calcium (CAC score ≥10) and carotid intima-media thickness (cIMT) over the menopausal transition (MT) and by menopause stage.
METHODS
Nuclear magnetic resonance spectroscopy LDL subclasses were measured for a maximum of five time points. Coronary artery calcification and cIMT were measured for a maximum of two time points. LOESS (locally weighted regression with scatter smoothing) plots, linear mixed-effects models, and generalized estimating equations were used for analyses.
RESULTS
The study included 471 women (baseline: age, 50.2 ± 2.7 years; 79.0% premenopausal/early perimenopausal), of whom 221 had data on CAC or cIMT. Low-density lipoprotein subclasses increased over the MT, whereas intermediate density-lipoprotein particles declined. In adjusted models, higher total LDL particles (LDL-P) and apolipoprotein B were associated with greater CAC prevalence and greater cIMT. Although none of the associations were modified by menopause stage, higher LDL-C, apolipoprotein B, and total LDL-P were associated with greater cIMT during the perimenopause or postmenopause stages, whereas higher LDL-C and small LDL-P were associated with greater CAC prevalence, mainly during perimenopause.
CONCLUSIONS
During the MT, women experience significant increases in LDL subclasses found to be related to greater cIMT levels and CAC prevalence. Whether these changes could better predict future risk of hard cardiovascular disease events beyond LDL-C remains a research question to address.
目的
围绝经期女性的低密度脂蛋白胆固醇（LDL-C）水平急剧升高，这与她们日后发生颈动脉斑块的风险增加有关。除了 LDL-C 之外，低密度脂蛋白亚类与心血管疾病有关，这为更好地进行风险分层提供了可能。我们旨在描述 LDL 亚类的变化，并评估其与绝经过渡期间（MT）及绝经后阶段的冠状动脉钙（CAC 评分≥10）和颈动脉内膜中层厚度（cIMT）的相关性。
方法
使用核磁共振光谱法（NMR）测量 LDL 亚类，最多可测量 5 个时间点。对冠状动脉钙化和 cIMT 最多可测量 2 个时间点。采用局部加权回归散点平滑（LOESS）图、线性混合效应模型和广义估计方程进行分析。
结果
该研究纳入了 471 名女性（基线年龄为 50.2±2.7 岁，79.0%为绝经前/早期围绝经期），其中 221 名女性有 CAC 或 cIMT 数据。MT 期间 LDL 亚类增加，而中间密度脂蛋白颗粒减少。在调整模型中，总 LDL 颗粒（LDL-P）和载脂蛋白 B 较高与 CAC 发生率和 cIMT 增加有关。尽管这些关联均不受绝经阶段的影响，但在围绝经期或绝经后阶段，较高的 LDL-C、载脂蛋白 B 和总 LDL-P 与更大的 cIMT 相关，而较高的 LDL-C 和小的 LDL-P 与更大的 CAC 发生率相关，主要发生在围绝经期。
结论
在 MT 期间，女性 LDL 亚类显著增加，这些变化与更大的 cIMT 水平和 CAC 发生率有关。这些变化是否能更好地预测 LDL-C 以外的未来硬心血管疾病事件的风险，仍是一个需要解决的研究问题。
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