Heianza Yoriko, Sun Qi, Wang Xuan, Tiwari Saumya, Watrous Jeramie D, Rexrode Kathryn M, Alotaibi Mona, Jain Mohit, Mora Samia, Willett Walter C, Qi Lu, Manson JoAnn E
Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA 70112, USA.
Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
Eur J Prev Cardiol. 2025 Apr 2;32(5):404-414. doi: 10.1093/eurjpc/zwae288.
Erythritol, a sugar alcohol (polyol), has recently been linked to the risk of major adverse cardiovascular events. We investigated whether plasma erythritol and other polyols (mannitol/sorbitol) were associated with the risk of incident coronary heart disease (CHD).
This prospective nested case-control study included 762 incident cases of CHD and 762 controls from the Nurses' Health Study. Plasma concentrations of polyols were measured at baseline (1989-90 or 2000-02). Associations of erythritol with cardiometabolic risk factors were also analysed in the Women's Lifestyle Validation Study (n = 728; blood collected in 2010-12). Higher erythritol levels were related to more adverse cardiometabolic risk factor status. A relative risk (RR) for CHD per 1-SD increment was 1.15 [95% confidence interval (CI): 1.04, 1.28] for erythritol and 1.16 (95% CI: 1.05, 1.28) for mannitol/sorbitol, after adjusting for diet quality, lifestyles, and adiposity. Compared with women in the lowest quartile, those in the highest quartile (Q4) of erythritol had an RR of 1.55 (95% CI: 1.13, 2.14) for CHD. The RR in the Q4 of erythritol was 1.61 (95% CI: 1.15, 2.24; P = 0.006) when hypertension and dyslipidaemia were further added to the model; the RR was 1.21 (95% CI: 0.86, 1.70) after adjustment for diabetes. For mannitol/sorbitol, the RR in Q4 was 1.42 (95% CI: 1.05, 1.91; P = 0.022) for CHD in the multivariable-adjusted model including diabetes.
Higher levels of plasma erythritol and mannitol/sorbitol were related to elevated risks of CHD even after adjustment for diet, lifestyles, adiposity, and other risk factors. The unfavourable association of mannitol/sorbitol, but not of erythritol, with CHD risk remained significant independent of diabetes/hyperglycaemia.
赤藓糖醇，一种糖醇（多元醇），最近被认为与主要不良心血管事件风险有关。我们调查了血浆赤藓糖醇和其他多元醇（甘露醇/山梨醇）是否与冠心病（CHD）发病风险相关。
这项前瞻性巢式病例对照研究纳入了来自护士健康研究的762例冠心病新发病例和762例对照。在基线时（1989 - 1990年或2000 - 2002年）测量血浆多元醇浓度。还在女性生活方式验证研究（n = 728；2010 - 2012年采集血液）中分析了赤藓糖醇与心血管代谢危险因素的关联。较高的赤藓糖醇水平与更不利的心血管代谢危险因素状态相关。调整饮食质量、生活方式和肥胖因素后，赤藓糖醇每增加1个标准差，冠心病的相对风险（RR）为1.15 [95%置信区间（CI）：1.04，1.28]，甘露醇/山梨醇为1.16（95% CI：1.05，1.28）。与处于最低四分位数的女性相比，处于赤藓糖醇最高四分位数（Q4）的女性患冠心病的RR为1.55（95% CI：1.13，2.14）。当模型中进一步加入高血压和血脂异常时，赤藓糖醇Q4的RR为1.61（95% CI：1.15，2.24；P = 0.006）；调整糖尿病因素后，RR为1.21（95% CI：0.86，1.70）。对于甘露醇/山梨醇，在包括糖尿病的多变量调整模型中，Q4时冠心病的RR为1.42（95% CI：1.05，1.91；P = 0.022）。
即使在调整饮食、生活方式、肥胖和其他危险因素后，较高水平的血浆赤藓糖醇和甘露醇/山梨醇仍与冠心病风险升高相关。甘露醇/山梨醇而非赤藓糖醇与冠心病风险的不利关联在独立于糖尿病/高血糖的情况下仍然显著。
