Sex-specific differences in the predictive value of cholesterol homeostasis markers and 10-year cardiovascular disease event rate in Framingham Offspring Study participants.
Sex-specific differences in the predictive value of cholesterol homeostasis markers and 10-year cardiovascular disease event rate in Framingham Offspring Study participants.
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DOI：
10.1161/jaha.112.005066
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发表时间：
2013-02-19
影响因子：
5.4
通讯作者：
Lichtenstein AH
中科院分区：
文献类型：
--
作者：
Matthan NR;Zhu L;Pencina M;D'Agostino RB;Schaefer EJ;Lichtenstein AH
关于影响血浆胆固醇稳态标记物浓度的因素及其在预测后续心血管疾病(CVD)事件中的价值，现有数据并不一致。为了解决这一问题，在弗雷明翰后代研究参与者(周期6)中，评估了胆固醇吸收的标记物(油菜籽甾醇、谷甾醇、胆甾醇)和合成(角鲨烯、桥本甾醇、催产素)与10年心血管疾病发病率的关系，这些参与者在基线时没有心血管疾病，也没有服用降脂药物(N=2616)。主要终点是“硬”冠心病(HCHD；冠状动脉死亡和心肌梗死)，次要终点是完全性CVD(HCHD合并中风、冠状动脉功能不全、心绞痛、外周动脉疾病和充血性心力衰竭)。在横断面分析中，观察到性别、年龄、体重指数、血压和吸烟状况的显著差异。在女性和男性中，较低的胆固醇吸收与较高的甘油三酯和较低的高密度脂蛋白胆固醇浓度相关，而较低的胆固醇合成与较高的低密度脂蛋白胆固醇浓度相关(P为Trend<；0.05)。仅在女性中，较低的胆固醇合成和吸收与较高的非高密度脂蛋白胆固醇浓度相关。使用COX比例风险模型调整标准的CVD危险因素，角鲨烯浓度与女性较低的HCHD相关(风险比=0.70[0.5至0.9])。相反，角鲨烯浓度(危险比=1.4[1.1至1.8])与男性较高的六氯甲烷浓度相关(P<；0.0001交互作用)。无论女性还是男性，胆固醇吸收标记物都不能预测高血压病或全身性心血管疾病。这些数据表明，胆固醇合成标记物和HCHD的10年预后价值存在显著的性别差异，特别是冠状动脉死亡和心肌梗死的发生率。网址：http://ClinicalTrials.gov.唯一标识：NCT00074464。
Available data are inconsistent regarding factors influencing plasma cholesterol homeostasis marker concentrations and their value in predicting subsequent cardiovascular disease (CVD) events. To address this issue, the relationship between markers of cholesterol absorption (campesterol, sitosterol, cholestanol) and synthesis (squalene, desmosterol, lathosterol) and 10‐year CVD incidence was assessed in Framingham Offspring Study participants (cycle 6) who were without CVD at baseline and not taking lipid‐lowering medications (N=2616). The primary end point was “hard” coronary heart disease (HCHD; coronary death and myocardial infarction), and the secondary end point was full CVD (HCHD plus stroke, coronary insufficiency, angina pectoris, peripheral artery disease, and congestive heart failure). In cross‐sectional analysis, significant differences by sex, age, body mass index, blood pressure, and smoking status were observed. In both women and men, lower cholesterol absorption was associated with higher triglyceride and lower high‐density lipoprotein (HDL) cholesterol concentrations, whereas lower cholesterol synthesis was associated with higher low‐density lipoprotein (LDL) cholesterol concentrations (P for trend <0.05). In women only, lower cholesterol synthesis and absorption were associated with higher non–HDL cholesterol concentrations. Using Cox proportional hazards model adjusting for standard CVD risk factors, squalene concentrations were associated with lower HCHD in women (hazard ratio=0.70 [0.5 to 0.9]). In contrast, squalene (hazard ratio=1.40 [1.1 to 1.8]) concentrations were associated with higher HCHD in men (P<0.0001 for interaction). The cholesterol absorption markers were not predictive of HCHD or full CVD in either women or men. These data suggest significant sex differences in the 10‐year prognostic value of cholesterol synthesis markers and HCHD, specifically coronary death and incidence of myocardial infarction. URL:http://ClinicalTrials.gov. Unique identifier: NCT00074464.