Lp(a)与脑卒中和脑损伤在MRI上的关联：来自HCHS/SOL（西班牙裔社区健康研究/拉丁裔研究）和神经认知衰老MRI （SOL- inca MRI）调查的见解。

IF 7.8 1区医学 Q1 CLINICAL NEUROLOGY

Stroke Pub Date : 2025-06-01 Epub Date: 2025-04-01 DOI:10.1161/STROKEAHA.124.048439

Akhil Avunoori Chandra, Priscilla Duran Luciano, Katrina Swett, Robert Kaplan, Gregory A Talavera, Melissa Lamar, Wassim Tarraf, Freddie Marquez, Parag H Joshi, Linda Gallo, Daniela Sotres-Alvarez, Morgan Gianola, Martha L Daviglus, Daniel L Labovitz, Hector Gonzalez, Charles DeCarli, Carlos J Rodriguez

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引用次数: 0

摘要

背景：脂蛋白（脂蛋白[a]）是心血管疾病的危险因素；然而，其与脑血管疾病的关系尚不明确。方法：来自西班牙裔/拉丁裔人群队列的数据包括16333名基线Lp(a)水平（nmol/L）和自我报告的流行中风或短暂性脑缺血发作（TIA）的个体。2642名接受脑磁共振成像的个体也被纳入其中。线性和多变量逻辑回归评估Lp(a)与(1)自我报告的卒中或TIA，(2)脑损伤定义为自我报告的卒中或TIA或脑磁共振成像的卒中证据，(3)白质高强度体积，(4)无症状脑梗死的关系。采用HCHS/SOL（西班牙裔社区健康研究/拉丁裔研究）复杂样本设计，采用抽样权重。结果：平均年龄±SE为41.1±0.3岁，女性占52.0%,Lp(a)水平中位数四分位数差（Q1, Q3）为19.7 (7.3-60.6)nmol/L；脑磁共振成像亚群平均年龄±SE为49.9±0.4岁，56.4%为女性，中位（四分位间距）Lp(a)水平为21.7 (8.1-62.9)nmol/L。对数转换的Lp(a)每增加一个单位，自我报告卒中或TIA的几率就会增加(优势比为1.13 [95% CI, 1.01-1.27]；P = 0.03)。与Lp(a)相比，最高五分位数（bbb77 nmol/L）的Lp(a)水平与较高的卒中或TIA发生率显著相关（P=0.02）。Q5脑损伤比例最高，Q2脑损伤比例最低。Lp(a) bbb77 nmol/L与Lp(a) 6 ~ P=0.03比较。log-Lp(a)每增加一个单位与log-白质高强度增加0.10相关(β, 0.10；P = 0.005)。Lp(a)与无症状性脑梗死无显著相关性。结论：Lp(a)与西班牙裔/拉丁裔人群中流行的卒中/TIA和白质高强度独立且显著相关。

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Association of Lp(a) With Stroke and Cerebral Injury on MRI: Insights From the HCHS/SOL (Hispanic Community Health Study/Study of Latinos) and Investigation of Neurocognitive Aging MRI (SOL-INCA MRI).

Background: Lp(a) (lipoprotein[a]) is a risk factor for cardiovascular disease; however, its association with cerebrovascular disease is not as well established.

Methods: Data from a population-based cohort of Hispanics/Latinos included 16 333 individuals with baseline Lp(a) levels (nmol/L) and self-reported prevalent stroke or transient ischemic attack (TIA). A subset of 2642 individuals with brain magnetic resonance imaging was also included. Linear and multivariate logistic regression assessed the association of Lp(a) with (1) self-reported stroke or TIA, (2) cerebral injury defined as self-reported stroke or TIA or evidence of a stroke on brain magnetic resonance imaging, (3) white matter hyperintensity volume, and (4) silent brain infarcts. Sampling weights were utilized given the HCHS/SOL (Hispanic Community Health Study/Study of Latinos) complex sample design.

Results: Mean age±SE was 41.1±0.3 years, 52.0% women, and median interquartile range (Q₁, Q₃) Lp(a) level of 19.7 (7.3-60.6) nmol/L; brain magnetic resonance imaging subset mean age±SE was 49.9±0.4 years, 56.4% women, and median (interquartile range) Lp(a) level of 21.7 (8.1-62.9) nmol/L. Each unit increase in log-transformed Lp(a) was associated with higher odds of self-reported stroke or TIA (odds ratio, 1.13 [95% CI, 1.01-1.27]; P=0.03). Lp(a) levels in the highest quintile (>77 nmol/L) were significantly associated with higher odds of prevalent stroke or TIA compared with Lp(a) <6 nmol/L (first quintile: odds ratio, 1.74 [95% CI, 1.09-2.77]; P=0.02). The highest proportion of cerebral injury was noted in Q5, while the lowest proportion was noted in Q2. When comparing Lp(a) >77 nmol/L with Lp(a) of 6 to <13 nmol/L (second quintile), a significant association was found between Lp(a) and cerebral injury that persisted after fully adjusted models (odds ratio, 2.03 [95% CI, 1.05-3.93]; P=0.03). Each unit increase in log-Lp(a) was associated with a 0.10 increase in log-white matter hyperintensity (β, 0.10; P=0.005). No significant association was found between Lp(a) and silent brain infarcts.

Conclusions: Lp(a) is independently and significantly associated with prevalent stroke/TIA, and white matter hyperintensity, in a large diverse population of Hispanics/Latinos.

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.