Causal associations of blood lipids with risk of ischemic stroke and intracerebral hemorrhage in Chinese adults

被引：370

作者：

Sun, Luanluan ^{[1
,2
]}

Clarke, Robert ^{[1
,2
]}

Bennett, Derrick ^{[1
,2
]}

Guo, Yu ^{[3
]}

Walters, Robin G. ^{[4
]}

Hill, Michael ^{[4
]}

Parish, Sarah ^{[4
]}

Millwood, Iona Y. ^{[4
]}

Bian, Zheng ^{[3
]}

Chen, Yiping ^{[1
,2
,4
]}

Yu, Canqing ^{[5
]}

Lv, Jun ^{[5
]}

Collins, Rory ^{[1
,2
]}

Chen, Junshi ^{[6
]}

Peto, Richard ^{[1
,2
]}

Li, Liming ^{[5
]}

Chen, Zhengming ^{[1
,2
]}

Avery, Daniel ^{[1
,2
]}

Bennett, Derrick ^{[1
,2
]}

Boxall, Ruth ^{[1
,2
]}

Bragg, Fiona ^{[1
,2
]}

Chang, Yumei ^{[1
,2
]}

Chen, Yiping ^{[1
,2
,4
]}

Clarke, Robert ^{[1
,2
]}

Du, Huaidong ^{[1
,2
]}

Gilbert, Simon ^{[1
,2
]}

Hacker, Alex ^{[1
,2
]}

Holmes, Michael ^{[1
,2
]}

Kartsonaki, Christiana ^{[1
,2
]}

Kerosi, Rene ^{[1
,2
]}

Lancaster, Garry ^{[1
,2
]}

Lin, Kuang ^{[1
,2
]}

McDonnell, John ^{[1
,2
]}

Millwood, Iona ^{[1
,2
]}

Nie, Qunhua ^{[1
,2
]}

Radhakrishnan, Jayakrishnan ^{[1
,2
]}

Ryder, Paul ^{[1
,2
]}

Sansome, Sam ^{[1
,2
]}

Schmidt, Dan ^{[1
,2
]}

Sohoni, Rajani ^{[1
,2
]}

Turnbull, Iain ^{[1
,2
]}

Wang, Jenny ^{[1
,2
]}

Wang, Lin ^{[1
,2
]}

Wright, Neil ^{[1
,2
]}

Yang, Ling ^{[1
,2
]}

Yang, Xiaoming ^{[1
,2
]}

Bian, Zheng ^{[3
]}

Guo, Yu ^{[3
]}

Han, Xiao ^{[3
]}

Hou, Can ^{[3
]}

机构：

[1] Univ Oxford, Nuffield Dept Populat Hlth, Clin Trial Serv Unit, Oxford, England

[2] Univ Oxford, Nuffield Dept Populat Hlth, Epidemiol Studies Unit, Oxford, England

[3] Chinese Acad Med Sci, Beijing, Peoples R China

[4] Univ Oxford, Nuffield Dept Populat Hlth, MRC Populat Hlth Res Unit, Oxford, England

[5] Peking Univ, Sch Publ Hlth, Dept Epidemiol & Biostat, Beijing, Peoples R China

[6] China Natl Ctr Food Safety Risk Assessment, Beijing, Peoples R China

[7] Qingdao CDC, NCD Prevent & Control Dept, Qingdao, Shandong, Peoples R China

[8] Licang CDC, NCD Prevent & Control Dept, Qingdao, Shandong, Peoples R China

[9] Heilongjiang CDC, NCD Prevent & Control Dept, Harbin, Heilongjiang, Peoples R China

[10] Nangang CDC, NCD Prevent & Control Dept, Harbin, Heilongjiang, Peoples R China

[11] Hainan Prov CDC, NCD Prevent & Control Dept, Haikou, Hainan, Peoples R China

[12] Meilan CDC, NCD Prevent & Control Dept, Haikou, Hainan, Peoples R China

[13] Jiangsu Prov CDC, NCD Prevent & Control Dept, Nanjing, Jiangsu, Peoples R China

[14] Wuzhong CDC, NCD Prevent & Control Dept, Suzhou, Peoples R China

[15] Guangxi Prov CDC, NCD Prevent & Control Dept, Nanning, Peoples R China

[16] Liuzhou CDC, NCD Prevent & Control Dept, Liubei, Liuzhou, Peoples R China

[17] Sichuan Prov CDC, NCD Prevent & Control Dept, Chengdu, Sichuan, Peoples R China

[18] Pengzhou CDC, NCD Prevent & Control Dept, Chengdu, Sichuan, Peoples R China

[19] Gansu Prov CDC, NCD Prevent & Control Dept, Lanzhou, Gansu, Peoples R China

[20] Maijixiang CDC, NCD Prevent & Control Dept, Maijixiang, Tianshui, Peoples R China

[21] Henan Prov CDC, NCD Prevent & Control Dept, Zhengzhou, Henan, Peoples R China

[22] Huixian CDC, NCD Prevent & Control Dept, Huixian, Peoples R China

[23] Zhejiang Prov CDC, NCD Prevent & Control Dept, Hangzhou, Zhejiang, Peoples R China

[24] Tongxiang CDC, NCD Prevent & Control Dept, Tongxiang, Peoples R China

[25] Hunan Prov CDC, NCD Prevent & Control Dept, Changsha, Hunan, Peoples R China

[26] Liuyang CDC, NCD Prevent & Control Dept, Liuyang, Peoples R China

来源：

NATURE MEDICINE | 2019年 / 25卷 / 04期

基金：

英国医学研究理事会; 英国惠康基金; 中国国家自然科学基金;

关键词：

CORONARY-HEART-DISEASE; SERUM-CHOLESTEROL; CARDIOVASCULAR-DISEASE; MYOCARDIAL-INFARCTION; LDL CHOLESTEROL; INDIVIDUAL DATA; MORTALITY; ATORVASTATIN; METAANALYSIS; PREVENTION;

D O I：

10.1038/s41591-019-0366-x

中图分类号：

Q5 [生物化学]; Q7 [分子生物学];

学科分类号：

070307 [化学生物学]; 071010 [生物化学与分子生物学];

摘要：

Stroke is the second leading cause of death worldwide and accounts for >2 million deaths annually in China(1,2). Ischemic stroke (IS) and intracerebral hemorrhage (ICH) account for an equal number of deaths in China, despite a fourfold greater incidence of IS1,2. Stroke incidence and ICH proportion are higher in China than in Western populations(3-5), despite having a lower mean low-density lipoprotein cholesterol (LDL-C) concentration. Observational studies reported weaker positive associations of LDL-C with IS than with coronary heart disease (CHD)(6,7), but LDL-C-lowering trials demonstrated similar risk reductions for IS and CHD8-10. Mendelian randomization studies of LDL-C and IS have reported conflicting results(11-13), and concerns about the excess risks of ICH associated with lowering LDL-C-14,C-15 may have prevented the more widespread use of statins in China. We examined the associations of biochemically measured lipids with stroke in a nested case-control study in the China Kadoorie Biobank (CKB) and compared the risks for both stroke types associated with equivalent differences in LDL-C in Mendelian randomization analyses. The results demonstrated positive associations of LDL-C with IS and equally strong inverse associations with ICH, which were confirmed by genetic analyses and LDL-C-lowering trials. Lowering LDL-C is still likely to have net benefit for the prevention of overall stroke and cardiovascular disease in China.

引用

页码：569 / +

页数：13

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