Association of abnormal serum lipids in elderly persons with atherosclerotic vascular disease and dementia, atherosclerotic vascular disease without dementia, dementia without atherosclerotic vascular disease, and no dementia or atherosclerotic vascular disease

BACKGROUND: Observational data have shown that the use of statins was associated with a lower prevalence of vascular dementia and of Alzheimer's disease. METHODS: We investigated in an academic nursing home the association of dyslipidemia with atherosclerotic vascular disease (group 1), atherosclerotic vascular disease without dementia (group 2), dementia without atherosclerotic vascular disease (group 3), and no dementia or atherosclerotic vascular disease (group 4). RESULTS: Increased serum low-density lipoprotein (LDL) cholesterol was present in 36 of 50 group 1 patients (72%), in 34 of 50 group 2 patients (68%), in 34 of 50 group 3 patients (68%), and in 18 of 50 group 4 patients (36%) (p =.0003 for 1 versus 4; p = 0.001 for 2 versus 4 and 3 versus 4). Decreased serum high-density lipoprotein (HDL) cholesterol was present in 34 of 50 group 1 patients (68%), in 35 of 50 group 2 patients (70%), in 32 of 50 group 3 patients (64%), and in 16 of 50 group 4 patients (32%) (p =.0003 for 1 versus 4; p =.0001 for 2 versus 4; p =.001 for 3 versus 4). Hypertriglyceridemia was not significantly different in the 4 groups. CONCLUSIONS: The prevalence of increased serum LDL cholesterol and decreased serum HDL cholesterol were significantly higher in elderly patients with atherosclerotic vascular disease plus dementia, atherosclerotic vascular disease without dementia, and dementia without atherosclerotic vascular disease than in patients with no dementia or atherosclerotic vascular disease.     

Association between plasma homocysteine and vascular atherosclerotic disease in older persons

Plasma homocysteine is a risk factor for coronary artery disease, stroke, extracranial carotid arterial disease, peripheral arterial disease, and aortic atherosclerosis in older persons. Randomized trials are in progress investigating whether multivitamin therapy to decrease plasma homocysteine levels will reduce the risk for cardiovascular disease.     

Blood levels of homocysteine and atherosclerotic vascular disease

In contrast to cross-sectional and case-control studies, which tend to report strong positive associations between plasma homocysteine and vascular risk, many prospective epidemiologic studies indicate modest associations at most, whereas other prospective studies report no evidence of association. Thus, while homocysteine may represent a causal factor in atherothrombosis, it is also possible that homocysteine is a marker of preclinical disease, or a consequence of other factors more closely linked to risk. Randomized trials are necessary to test reliably whether lowering homocysteine levels will decrease risks of atherosclerotic vascular disease. Current guidelines from the American College of Cardiology and the American Heart Association do not support population-based homocysteine screening to determine cardiovascular risk.     

血管性痴呆患者与其血浆同型半胱氨酸水平的关系

目的 探讨血管性痴呆(VD)患者与其血浆同型半胱氨酸水平的关系.方法 用高效液相色谱仪和电化学检测法测定1998年2月至2000年2月收治的37例VD患者的血浆总同型半胱氨酸水平,并与40名正常同龄对照组及40例非痴呆脑梗死组比较.运用多聚酶链反应-限制性内切酶片段长度多态性技术(PCR-RFLP)检测N5,N10-亚甲基四氢叶酸还原酶(MTHFR)基因多态性,同时测定血浆叶酸及维生素B12水平.结果 VD患者血浆总同型半胱氨酸水平显著高于正常同龄对照组和非痴呆脑梗死组;MTHFR基因型有3种,即纯合子(T/T)型、杂合子(T/C)型和纯合子(C/C)型.3组基因型和等位基因频率相比,差异均无显著性;VD组血浆叶酸及维生素B12水平明显低于正常同龄对照组和非痴呆脑梗死组(P＜0.05).结论 高同型半胱氨酸血症可能是VD发病的一个新的危险因素.     

Frequency of subclinical heart disease in elderly persons with dementia

The authors compared the frequency of structural and functional heart abnormalities assessed using transthoracic echocardiography among persons with Alzheimer's disease, vascular dementia, stroke, and healthy control subjects. Compared with controls, patients with Alzheimer's disease were more likely to have aortic valve thickening, aortic valve regurgitation, left ventricular wall motion abnormalities, left ventricular hypertrophy, and reduced ejection fraction. Persons with vascular dementia were more likely to have aortic valve regurgitation, but mitral valve thickening and tricuspid valve regurgitation were also more frequent. In the absence of dementia, persons with stroke differed from controls by more frequent mitral valve calcifications. With the increasing prevalence of Alzheimer's disease and vascular dementia, clinicians have to be more attentive to the presence of structural heart disease and its complications in persons with these conditions.     

Plasma homocysteine and inflammation in elderly patients with cardiovascular disease and dementia

Increased levels of plasma total homocysteine (tHcy) may play a role in both cardiovascular diseases (CVD) and old-age dementias via enhancement of vascular inflammation. However, the association between plasma tHcy and serum C-reactive protein (sCRP), taken as a marker of low-grade inflammation, is still uncertain. We investigated this association in normal aging, CVD, and dementia, and examined whether it was modified by the presence of two major comorbid diseases of older age: chronic obstructive pulmonary disease (CPOD) and peptic ulcer (PU). Six hundred-twenty-seven individuals aged > or = 65 yr (74+/-7 yr) were selected for this study: 373 healthy controls; 160 patients with CVD but no evidence of comorbid diseases (CVD+/comorbidity-); 46 patients with CVD and concurrent CPOD and/or PU (CVD+/comorbidity+); and 48 patients with dementia. A positive association between plasma tHcy and serum CRP, independent of several confounders (socio-demographic status, known tHcy and sCRP determinants, inflammation markers, traditional vascular risk factors), was found for CVD+/comorbidity+ (p=0.001; not affected by dementia type) and dementia (p=0.001; not affected by dementia type), but not for CVD+/comorbidity- and controls. The results suggest that the association between plasma tHcy and sCRP is more an aspecific reflection of poor health than a specific correlate of vascular inflammation.     

血浆高半胱氨酸水平与动脉粥样硬化性类烟雾病的相关性

目的 探讨血浆高半胱氨酸(homocysteine,Hcy)水平与动脉粥样硬化性类烟雾病的关系.方法 选取动脉粥样硬化性类烟雾病缺血性卒中患者(类烟雾病组)95例、大动脉粥样硬化性卒中患者(卒中组)95例、健康志愿者(对照组)94例.检测血浆Hcy水平,收集人口统计学资料、血管危险因素和实验室检查结果 .分析血浆Hcy水平与动脉粥样硬化性类烟雾病的相关性.结果 类烟雾病组高血压、高脂血症、既往卒中或短暂性脑缺血发作(transient ischemic attack,TIA)史、高同种半胱氨酸血症(hyperhomocysteinemia,HHcy)的患者构成比以及收缩压、总胆固醇、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、Hcy、维生素B12、叶酸水平与对照组比较差异有统计学意义(P均<0.017);类烟雾病组既往卒中或TIA史的患者构成比以及收缩压和叶酸水平与卒中组比较差异有统计学意义(P均<0.017).与对照组比较,多变量logistic回归分析显示,HHcy[优势比(odds ratio,OR)1.806,95%可信区间(confidence interval,CI)1.348~2.420;P<0.001]、 既往卒中或TIA史(OR 3.519,95%CI 1.709~7.028;P=0.013)、收缩压(OR 1.099,95%CI 1.035~1.168;P=0.002)、LDL-C(OR 38.473,95%CI 6.384~231.842;P<0.001)是动脉粥样硬化性类烟雾病的独立危险因素,HDL-C(OR 0.025,95%CI 0.001~0.768;P=0.035)和叶酸(OR 0.779,95%CI 0.608~0.996;P=0.047)是其独立保护因素;与卒中组比较,多变量logistic回归分析显示,既往卒中或TIA史(OR 3.280,95%CI 1.664~6.466;P=0.001)、收缩压(OR 1.019,95%CI 1.002~1.035;P=0.029)是类烟雾病的独立危险因素,叶酸(OR 0.845,95%CI 0.750~0.952;P=0.006)是其独立保护因素.结论 血浆Hcy水平升高是动脉粥样硬化性类烟雾病的独立危险因素,在其发病机制中起重要作用.     

Homocysteine. The association with atherosclerotic vascular disease in older persons

Plasma homocysteine is a risk factor for coronary artery disease, stroke, peripheral arterial disease, extracranial carotid arterial disease, aortic atherosclerosis, deep vein thrombosis, and possibly dementia and Alzheimer's disease in older persons. Randomized trials are in progress investigating whether multivitamin therapy with folic acid, vitamin B12, and vitamin B6 to reduce plasma homocysteine levels will reduce the risk for atherosclerotic vascular disease.     

Association of plasma homocysteine concentrations with carotid atherosclerosis in elderly Japanese

OBJECTIVE: Homocysteine (Hcy) is a sulfhydryl amino acid. Its precursor, the essential amino acid methionine, is derived from dietary protein; recently a number of studies have suggested its relation to atherosclerosis. The present study was performed to clarify the relation between the plasma Hcy concentration and sclerotic lesions of the common carotid arteries. METHODS AND PATIENTS: We evaluated sclerotic lesions of common carotid arteries by ultrasonography in 120 elderly in-patients (77+ /- 9 years), and studied the relationship of the known risk factors for atherosclerosis including plasma Hcy. An ultrasonograph and 7.5 MHz linear type B-mode probe were used by a specialist to evaluate sclerotic lesions of the common carotid arteries. Blood was drawn from the patients while fasting for determination of plasma Hcy. Plasma Hcy concentrations were determined using a high-performance liquid chromatography assay. RESULTS: Logistic regression analysis using IMT as an object variable, adjusted by various risk factors including the plasma Hcy concentration, revealed that the relative risk in the group combining the second and the third highest Hcy groups was 6.49 (95% confidence interval (CI): 1.95-21.9) compared with the first group and the plaque presence showed a relative risk of 4.45 (95% CI: 1.53-12.9). CONCLUSION: The findings of this study confirmed that observations of an association between plasma Hcy concentration and common carotid atherosclerosis in Western populations is also present among the elderly Japanese.     

Association between plasma homocysteine concentrations and asymptomatic cerebral infarction or leukoaraiosis in elderly diabetic patients

Background: The purpose of the present study was to investigate the possible contribution of plasma homocysteine to asymptomatic cerebral infarction (CI) or leukoaraiosis. Methods: The relationship between plasma homocysteine concentrations and cerebral lesions was investigated in 233 elderly diabetic patients (mean age: 74 years) who were divided into three groups based on the neurological and brain MR findings: asymptomatic cerebral infarction (CI), symptomatic CI, and a control group with no evidence of cerebrovascular disease. Plasma total homocysteine concentrations were measured by high‐performance liquid chromatography. The C677T polymorphism in the methylene tetrahydrofolate reductase (MTHFR) gene was assessed by PCR‐RFLP. The total score of T2 high‐intensity lesions on the brain MR images was summed from the focal T2 high‐intensity scores in 24 areas of the brain. Results: Diabetic patients with asymptomatic or symptomatic CI had significantly higher homocysteine concentrations in plasma than the control group. The plasma homocysteine concentration was more strongly associated with the presence and number of small infarctions or infarction of the putamen, which may explain the association between increased plasma homocysteine concentrations and asymptomatic CI in elderly diabetic patients. In the diabetic patients, high plasma homocysteine concentrations were also significantly associated with high scores of total T2 high‐intensity lesions or focal T2 high‐intensity scores in some periventricular regions. Although there was no significant relationship between the MTHFR TT genotype and CI, a significant association was found between the MTHFR TT genotype and total T2 high‐intensity scores. Conclusion: An elevated plasma homocysteine concentration is independently associated with asymptomatic CI and T2 high‐intensity lesions on brain MR images in elderly patients with diabetes mellitus. The association between the MTHFR TT genotype and periventricular T2 high‐intensity lesions, but not with CI, suggests an important effect of C677T MTHFR gene mutation on leukoaraiosis, independent of hyperhomocysteinemia in elderly diabetic patients.     

血管内皮功能和同型半胱氨酸对老年冠心病患者发病的相关性探讨

目的探讨血管内皮功能和同型半胱氨酸(Hcy)在老年冠心病患者中的作用机制。方法选取老年冠心病患者150例,根据诊断分为陈旧性心肌梗死组56例,稳定性心绞痛组51例,急性冠状动脉综合征组43例。对比各组患者Hcy水平、高血压、吸烟史、TC、及LDL-C等,分析Hcy水平及内皮依赖型血管舒张率与冠心病严重程度的相关性。结果急性冠状动脉综合征组Hcy水平升高比例显著高于稳定性心绞痛组和陈旧性心肌梗死组(79.1%vs 14.3%,29.4%,P=0.000)。3组间Hcy水平正常及升高比例比较差异有统计学意义(P=0.000)。急性冠状动脉综合征组Hcy水平显著高于稳定性心绞痛组及陈旧性心肌梗死组[(19.8±7.2)μmol/L vs(11.0±4.5)μmol/L,(12.3±6.1)μmol/L,P<0.01],但内皮依赖型舒张率显著低于稳定性心绞痛组及陈旧性心肌梗死组[(4.1±2.8)%vs(7.5±5.1)%,(6.5±3.2)%,P<0.01]。相关分析显示,Hcy水平与冠心病严重程度呈正相关(r=6.332,P=0.038),而内皮依赖型血管舒张率与冠心病严重程度呈负相关(r=-7.254,P=0.038)。结论血管内皮功能及Hcy水平与老年冠心病患者的病情联系紧密,临床治疗时可对其进行监测,值得重视。     

Comparison of prevalence of atherosclerotic vascular disease in postmenopausal women with osteoporosis or osteopenia versus without osteoporosis or osteopenia

Atherosclerotic vascular disease (AVD) and osteoporosis or osteopenia are common conditions among postmenopausal women and appear to be linked in a manner that is not fully understood. In a retrospective study that was conducted among 1,000 postmenopausal women who were seen in a general medicine clinic, AVD was more commonly seen among women with osteoporosis (92 of 154, 60%) than among those with osteopenia (63 of 179, 35%, p <0.001) or no osteoporosis or osteopenia (148 of 667, 22%, p <0.001). AVD was also more prevalent in women with osteopenia than in those with no osteoporosis or osteopenia (p <0.001). Modifiable risk factors for AVD were present to the same extent in women with osteoporosis, osteopenia, or no osteoporosis or osteopenia.     

血浆同型半胱氨酸与缺血性脑血管病患者颈动脉粥样硬化斑块的关系

目的探讨缺血性脑血管病患者血浆同型半胱氨酸（Hcy）水平与颈动脉粥样硬化斑块的关系。方法选择327例发病时间≤7 d、首次发病的缺血性脑血管病患者,其中脑梗死264例,颈内动脉系统短暂性脑缺血发作（TIA）63例。采用颈动脉彩色多普勒超声检查颈动脉内-中膜厚度（IMT）,综合评估患者颈动脉粥样硬化程度及斑块性质。并根据超声结果将患者分为IMT正常组、IMT增厚组、斑块形成组;酶联免疫吸附法测定晨起空腹血浆Hcy浓度。分析血浆Hcy水平与颈动脉粥样硬化斑块的关系。结果①327例患者中,99例为IMT正常,40例为IMT增厚,188例为粥样斑块形成。在188例斑块形成的患者中,易损斑块组82例,非易损斑块组106例。②IMT正常组、IMT增厚组、斑块形成组的血浆Hcy浓度（中位数）分别为13.6、22.3、28.6μmol/L,高同型半胱氨酸血症（HHcy）的发生率分别为40.4%（40/99）、70.0%（28/40）、75.5%（142/188）。除IMT增厚组与斑块形成组间HHcy发生率差异无统计学意义外,3组间观察指标比较差异均有统计学意义（均P〈0.05）。③易损斑块组血浆Hcy浓度和HHcy发生率分别为28.9μmol/L和82.9%,高于非易损斑块组的23.4μmol/L和69.8%,差异均有统计学意义,P〈0.05。④多因素Logistic回归分析显示,Hcy浓度增高是颈动脉粥样斑块形成的独立危险因素（OR=1.14,95%CI：1.04～1.25）结论随着血浆Hcy水平的升高,颈动脉粥样硬化程度随之升高。HHcy是颈动脉粥样硬化斑块形成的独立危险因素。     

血管性痴呆患者认知功能与血浆同型半胱氨酸水平的关系

目的探讨血管性痴呆(VaD)患者认知功能与血浆同型半胱氨酸(Hcy)水平的关系。方法选取2013-06~2015-02在该院住院的VaD患者46例、同期收治的非痴呆性脑梗死患者50例以及同龄健康者40名。根据简易精神状态检查量表(MMSE)评分对VaD患者划分严重程度。观察各组血浆中Hcy、叶酸、维生素B_(12)水平及其与VaD严重程度的关系。结果 VaD组及非痴呆性脑梗死组血浆Hcy水平高于健康组(P0.05),VaD组血浆Hcy水平高于非痴呆性脑梗死组(P0.05),VaD组叶酸及维生素B_(12)水平低于非痴呆性脑梗死组和健康组(P0.05),痴呆程度轻、中、重组Hcy浓度逐次升高,叶酸及维生素B_(12)浓度逐次降低(P0.05)。结论血浆Hcy浓度和VaD的发生和发展密切相关,高Hcy血症可能是导致VaD的危险因素之一,检测Hcy水平有助于VaD的防治。     

内皮型一氧化氮合酶基因多态性与缺血性脑血管病后非痴呆认知功能障碍的关系

目的探讨内皮型一氧化氮合酶(eNOS)基因多态性与缺血性脑血管病后血管性非痴呆认知功能障碍(V-CIND)的相关性。方法采用PCR-RFLP技术对100例缺血性脑血管病后V-CIND患者,80例缺血性脑血病患者认知功能正常患者(NoCI)和120例正常人的eNOS G894T和eNOS 4a的多态性进行测定。结果三组在eNOS G894T的基因型分布和等位基因的频率方面有统计学差异,V-CIND和NoCI含T的等位基因频率都高于对照组,且具有统计学意义,但此两者之间没有区别;三组在eNOS4a的含a等位基因的频率有差异,但无统计学意义。结论 eNOS G894T基因多态性与缺血性脑血管病变后V-CIND相关,T等位基因可能是其易感基因。