家庭高胆固醇和高低密度脂蛋白胆固醇与缺血性中风的关系:哥本哈根总人口研究
Sabina Beheshti1,2,3, Christian M Madsen1,2,3, Anette Varbo1,2,4
1Department of Clinical Biochemistry (S.B., C.M.M., A.V., B.G.N).
Circulation
|March 30, 2018
概括
家庭高胆固醇和高LDL胆固醇不会增加缺血性中风的风险. 之前的心脏病,而不是高LDL胆固醇本身,解释了FH患者观察到的中风风险.
科学领域:
- 心血管科学
- 遗传学
- 流行病学
背景情况:
- 家庭高胆固醇血症 (FH) 具有极高的低密度脂蛋白 (LDL) 胆固醇水平,显著增加缺血性心脏病的风险.
- FH,高LDL胆固醇与缺血性中风风险之间的关系尚不清楚,证据有限且相互矛盾.
- 这项研究调查了FH和LDL胆固醇升高是否独立地导致一般人群中缺血性中风的风险增加.
研究的目的:
- 确定患有家族性高胆固醇血症 (FH) 的人是否有较高的缺血性中风风险.
- 研究高低密度脂蛋白 (LDL) 胆固醇与缺血性中风风险之间的关系.
- 区分高LDL胆固醇对缺血性中风的直接影响与先前存在的缺血性心脏病的影响.
主要方法:
- 使用因果,遗传 (门德尔随机化) 和大型队列 (CGPS和CCHS) 的观察分析,包括超过10万个人.
- 检查了与LDL胆固醇相关的FH致病突变 (LDLR,APOB) 和常见的遗传变异.
- 评估了FH,LDL胆固醇水平和缺血性中风和心肌梗塞的发生率之间的关联.
主要成果:
- 与没有FH致病突变的个体相比,没有发现缺血性中风的风险增加 (P=0. 50).
- 在FH突变患者中,心肌梗塞的风险显著增加 (P< 0. 001).
- LDL胆固醇升高1mmol/ l显示缺血性中风的非显著遗传因果风险比为1.11,而心肌梗塞的显著风险比为1.45.
结论:
- 家庭高胆固醇血症 (FH) 和高LDL胆固醇并没有独立增加缺血性中风的风险.
- 在FH标准和缺血性中风风险之间观察到的关联可能归因于先前缺血性心脏病的存在.
- 高的LDL胆固醇是心肌梗塞的重要危险因素,而不是缺血性中风本身.
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