The 32-year relationship between cholesterol and dementia from midlife to late life
The 32-year relationship between cholesterol and dementia from midlife to late life
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DOI：
10.1212/wnl.0b013e3181feb2bf
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发表时间：
2010-11-23
期刊：
影响因子：
9.9
通讯作者：
Gustafson, D. R.
中科院分区：
文献类型：
--
作者：
Mielke, M. M.;Zandi, P. P.;Gustafson, D. R.
背景：细胞和动物研究表明，高胆固醇血症有助于阿尔茨海默病（AD）。然而，胆固醇和痴呆症之间的关系，在人口水平上是不太清楚，可能会有所不同的lifesty.Methods：前瞻性人口研究的妇女，包括1,462名妇女没有痴呆症的年龄在38-60岁，开始于1968-1969年在哥德堡，瑞典。在1974-1975年、1980-1981年、1992-1993年和2000-2001年进行了随访。根据DSM-III-R标准诊断全因痴呆，根据国家神经和交流障碍研究所和中风-阿尔茨海默病及相关疾病协会标准诊断AD。考克斯比例风险回归分析了所有参与者中与痴呆和AD事件相关的基线、时间依赖性和胆固醇水平变化。在2000-2001年的检查中，对存活至70岁或以上的参与者进行了重复分析。结果：1968年的高胆固醇水平与AD风险增加无关（最高与最低四分位数：风险比[HR] 2.82，95%置信区间[CI] 0.94-8.43）。虽然有没有胆固醇水平和痴呆症之间的关联时，考虑所有参与者超过32岁，随时间推移的胆固醇降低与痴呆症的风险增加（HR 2.35，95%CI 1.22-4.58）。结论：这些数据表明，中年胆固醇水平与AD的风险增加无关。然而，在那些存活到痴呆症风险年龄的人中可能存在轻微的风险。从中年到晚年的胆固醇水平下降可能比痴呆发作前一个时间点获得的水平更好地预测AD风险。在整个生命周期内检查这一风险因素和其他风险因素的分析策略可能会影响结果的解释。神经病学（R）2010;75：1888-1895
Background: Cellular and animal studies suggest that hypercholesterolemia contributes to Alzheimer disease (AD). However, the relationship between cholesterol and dementia at the population level is less clear and may vary over the lifespan.Methods: The Prospective Population Study of Women, consisting of 1,462 women without dementia aged 38-60 years, was initiated in 1968-1969 in Gothenburg, Sweden. Follow-ups were conducted in 1974-1975, 1980-1981, 1992-1993, and 2000-2001. All-cause dementia was diagnosed according to DSM-III-R criteria and AD according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria. Cox proportional hazards regression examined baseline, time-dependent, and change in cholesterol levels in relation to incident dementia and AD among all participants. Analyses were repeated among participants who survived to the age of 70 years or older and participated in the 2000-2001 examination.Results: Higher cholesterol level in 1968 was not associated with an increased risk of AD (highest vs lowest quartile: hazard ratio [HR] 2.82, 95% confidence interval [CI] 0.94-8.43) among those who survived to and participated in the 2000-2001 examination. While there was no association between cholesterol level and dementia when considering all participants over 32 years, a time-dependent decrease in cholesterol over the follow-up was associated with an increased risk of dementia (HR 2.35, 95% CI 1.22-4.58).Conclusion: These data suggest that midlife cholesterol level is not associated with an increased risk of AD. However, there may be a slight risk among those surviving to an age at risk for dementia. Declining cholesterol levels from midlife to late life may better predict AD risk than levels obtained at one timepoint prior to dementia onset. Analytic strategies examining this and other risk factors across the lifespan may affect interpretation of results. Neurology (R) 2010;75:1888-1895