血清抗氧化剂与心肌梗死。类胡萝卜素和α-生育酚水平低是心肌梗死的危险因素吗？

Serum antioxidants and myocardial infarction. Are low levels of carotenoids and alpha-tocopherol risk factors for myocardial infarction?

作者信息

Street D A, Comstock G W, Salkeld R M, Schüep W, Klag M J

机构信息

Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md.

出版信息

Circulation. 1994 Sep;90(3):1154-61. doi: 10.1161/01.cir.90.3.1154.

DOI:10.1161/01.cir.90.3.1154

PMID:8087925

Abstract

BACKGROUND

In vitro, animal and epidemiological studies suggest that lipoprotein oxidation may play an important role in atherosclerosis. Antioxidants may protect against lipoprotein oxidation and in that way inhibit atherosclerosis and its clinical sequelae. To investigate this possibility, we examined the association between levels of several antioxidants and myocardial infarction using serum specimens collected 7 to 14 years before the onset of myocardial infarction.

METHODS AND RESULTS

A nested case-control design was used. Cases and control subjects were selected from the 25,802 persons who had donated 15 mL of blood in 1974 for a serum bank. Cases comprised 123 persons with a subsequent first diagnosis of myocardial infarction who ranged from 23 through 58 years of age in 1974 and who had had their first diagnosis of myocardial infarction during 1981 to 1988. Two groups of control subjects matched to the cases for sex and age were selected from donors to the serum bank, one from those with hospital admissions during the same period and the other from the total group of donors. Sera were assayed for four carotenoids (beta-carotene, lycopene, lutein, and zeaxanthin), alpha-tocopherol, and cholesterol. Because associations with these serum nutrients showed similar trends whether based on hospital or community controls, the two control groups were combined. There was a significantly increasing risk for subsequent myocardial infarction with decreasing levels of beta-carotene in 1974 (P value for trend, .02) and a suggestive trend with decreasing levels of lutein (P = .09). When the results were stratified by smoking status, the excess risk of myocardial infarction associated with low serum levels of carotenoids was limited to smokers. A protective association with higher levels of alpha-tocopherol was suggested only among persons with high levels of serum cholesterol.

CONCLUSIONS

Low serum levels of carotenoids were associated with an increased risk of subsequent myocardial infarction among smokers.

摘要

背景

体外、动物及流行病学研究表明，脂蛋白氧化可能在动脉粥样硬化中起重要作用。抗氧化剂可能预防脂蛋白氧化，从而抑制动脉粥样硬化及其临床后果。为研究这种可能性，我们使用心肌梗死发病前7至14年采集的血清标本，检测了几种抗氧化剂水平与心肌梗死之间的关联。

方法与结果

采用巢式病例对照设计。病例和对照受试者选自1974年为血清库捐献15毫升血液的25802人。病例包括123名随后首次诊断为心肌梗死的患者，他们在1974年年龄为23至58岁，首次诊断心肌梗死的时间为1981年至1988年。从血清库的捐献者中选择两组与病例在性别和年龄上匹配的对照受试者，一组来自同期住院患者，另一组来自所有捐献者。检测血清中的四种类胡萝卜素（β-胡萝卜素、番茄红素、叶黄素和玉米黄质）、α-生育酚和胆固醇。由于无论基于医院对照还是社区对照，这些血清营养素的关联都呈现相似趋势，因此将两个对照组合并。1974年β-胡萝卜素水平降低时，随后发生心肌梗死的风险显著增加（趋势P值为0.02），叶黄素水平降低时有提示性趋势（P = 0.09）。按吸烟状况分层分析结果时，血清类胡萝卜素水平低与心肌梗死相关的额外风险仅限于吸烟者。仅在血清胆固醇水平高的人群中，提示α-生育酚水平较高有保护作用。