Serum plant and other noncholesterol sterols, cholesterol metabolism and 22-year mortality among middle-aged men
Serum plant and other noncholesterol sterols, cholesterol metabolism and 22-year mortality among middle-aged men
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DOI：
10.1016/j.atherosclerosis.2009.11.007
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发表时间：
2010-05-01
期刊：
影响因子：
5.3
通讯作者：
Miettinen, Tatu A.
中科院分区：
文献类型：
--
作者：
Strandberg, Timo E.;Gylling, Helena;Miettinen, Tatu A.
目的：评价血清非胆固醇类固醇(包括植物类固醇)对基线无他汀类药物的心血管疾病(CVD)高危中年男性的长期预后影响。大多数是高胆固醇血症，29(12%)有心血管疾病或癌症病史，6(3%)有糖尿病，46(20%)有代谢综合征(MS)。测量的非胆固醇类固醇(表示为绝对浓度或与血清胆固醇的比率，以标准化胆固醇浓度)包括植物类固醇(反映胆固醇合成)、植物类固醇(菜籽醇和谷甾醇)和胆甾醇(反映胆固醇吸收)。主要观察指标为总死亡率。结果：基线时，胆固醇合成和吸收的标记物表现出预期的负相关性。在22年的随访中，101名男性(43%)死亡。在基线时，死亡者吸烟更多，锻炼更少，多发性硬化症的成分更多(尽管没有达到严格的标准)，而传统的心血管疾病危险因素没有显著差异。在非胆固醇类固醇(无论是绝对值还是比值)中，仅存活组的谷甾醇显著高于死亡组(P=0.02)。在多变量分析中，与谷甾醇/胆固醇比值最低的三元组相比，谷甾醇/胆固醇比值最高的组死亡率风险显著降低(HR 0.51，95%CI 0.30-0.87)。其他的相关性并不显著，尽管一个胆固醇代谢的“全球”指数(Desmosterol-to-Sitosterol Ratio)表明，较高的胆固醇合成和较低的吸收与较高的总死亡率和心血管疾病死亡率相关。结论：中年男性较高的血清植物类固醇水平预示着较低的长期死亡风险，这可能反映了较高的胆固醇合成/较低吸收与死亡率之间的关联。(C)2009爱思唯尔爱尔兰有限公司。保留所有权利。
Objective: To evaluate long-term prognostic effect of serum noncholesterol sterols, including plant sterols, in middle-aged men with high cardiovascular disease (CVD) risk, without statins at baseline.Methods: This was a prospective study of 232 men (mean age 60 years) at high risk of CVD in 1985-1986. Most were hypercholesterolemic, 29(12%) had a history of CVD or cancer, 6(3%) had diabetes, and 46(20%) had metabolic syndrome (MS). Measured noncholesterol sterols (expressed as absolute concentrations or ratios to serum cholesterol to standardize for cholesterol concentrations) included lathosterol and desmosterol (reflect cholesterol synthesis), and plant sterols (campesterol and sitosterol) and cholestanol (reflect cholesterol absorption). Main outcome measure was total mortality.Results: At baseline, markers of cholesterol synthesis and absorption showed expected inverse associations. During the 22-year follow-up 101 men (43%) died. At baseline, nonsurvivors smoked more, exercised less and had more components of MS (although not filling strict criteria), whereas traditional risk factors of CVD were not significantly different. Of the noncholesterol sterols (either absolute or ratio), only sitosterol was significantly higher in survivors than in nonsurvivors (P = 0.02). In multivariable analyses, highest sitosterol-to-cholesterol tertile was associated with significantly lower mortality risk (HR 0.51, 95% CI 0.30-0.87) as compared to lowest tertile. Other associations were nonsignificant, although a "global" index of cholesterol metabolism (desmosterol-to-sitosterol ratio) suggested higher cholesterol synthesis and lower absorption to be associated with higher total and CVD mortality.Conclusion: Higher serum plant sterol levels in middle-aged men predicted lower long-term mortality risk, possibly reflecting an association between higher synthesis/lower absorption of cholesterol and mortality. (C) 2009 Elsevier Ireland Ltd. All rights reserved.