Lipid-Lowering Agents and High HDL (High-Density Lipoprotein) Are Inversely Associated With Intracranial Aneurysm Rupture.
Lipid-Lowering Agents and High HDL (High-Density Lipoprotein) Are Inversely Associated With Intracranial Aneurysm Rupture.
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DOI：
10.1161/strokeaha.117.019972
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发表时间：
2018-05
期刊：
影响因子：
8.3
通讯作者：
Du R
中科院分区：
文献类型：
--
作者：
Can A;Castro VM;Dligach D;Finan S;Yu S;Gainer V;Shadick NA;Savova G;Murphy S;Cai T;Weiss ST;Du R
来自实验动物模型和临床研究的越来越多的证据表明，他汀类药物对颅内动脉瘤破裂具有保护作用，然而，缺乏详细说明颅内动脉瘤破裂与总胆固醇、HDL、LDL和降脂药使用之间关系的大型研究结果。回顾和分析了1990年至2016年期间在马萨诸塞州总医院和布里格姆妇女医院诊断的4，701例患者的6，411例颅内动脉瘤的病历。患者分为破裂组和非破裂组。进行单变量和多变量logistic回归分析，以确定脂质（总胆固醇、LDL、HDL）和降脂药物对颅内动脉瘤破裂风险的影响。倾向评分加权用于解释队列基线特征的差异。使用降脂药与破裂状态呈显著负相关（OR 0.58，95%CI 0.47-0.71）。在包括降脂药使用和血脂值的完整病例的亚组分析中，较高的HDL水平（OR 0.95，95% CI 0.93-0.98）和降脂药使用（OR 0.41，95% CI 0.23-0.73）均与破裂状态显著负相关，而总胆固醇和LDL水平不显著。HDL水平与动脉瘤破裂风险之间呈单调的波动-反应曲线。高密度脂蛋白值和使用降脂药物与颅内动脉瘤破裂显著负相关。
Growing evidence from experimental animal models and clinical studies suggests the protective effect of statin use against rupture of intracranial aneurysms, however, results from large studies detailing the relationship between intracranial aneurysm rupture and total cholesterol, HDL, LDL, and lipid-lowering agent use are lacking. The medical records of 4,701 patients with 6,411 intracranial aneurysms diagnosed at the Massachusetts General Hospital and the Brigham and Women’s Hospital between 1990 and 2016 were reviewed and analyzed. Patients were separated into ruptured and non-ruptured groups. Univariable and multivariable logistic regression analyses were performed to determine the effects of lipids (total cholesterol, LDL, HDL) and lipid-lowering medications on intracranial aneurysm rupture risk. Propensity score weighting was used to account for differences in baseline characteristics of the cohorts. Lipid-lowering agent use was significantly inversely associated with rupture status (OR 0.58, 95% CI 0.47–0.71). In a subgroup analysis of complete cases that includes both lipid-lowering agent use and lipid values, higher HDL levels (OR 0.95, 95% CI 0.93–0.98) and lipid-lowering agent use (OR 0.41, 95% CI 0.23–0.73) were both significantly and inversely associated with rupture status, whereas total cholesterol and LDL levels were not significant. A monotonic exposure-response curve between HDL levels and risk of aneurysmal rupture was obtained. Higher HDL values and the use of lipid-lowering agents are significantly inversely associated with ruptured intracranial aneurysms.