A total of 1010 patients were evaluated, with 32 classified as having poor control after three months.
Outdoor artificial light at night () exposure is associated with poorer control of low-density lipoprotein cholesterol (LDL-C) in patients with intracranial artery atherosclerotic stenosis (ICAS).
For each increase of 1 nW/cm²/sr in ALAN intensity, the odds of poor LDL-C control increased by 2%.
Metabolic profiling suggests that ALAN may influence lipid metabolism through its effects on specific proteins involved in lipid transport.
Dim ALAN exposure in animal studies led to global hypomethylation, while melatonin treatment appeared to mitigate some of these effects.
The findings imply that disruptions in circadian rhythms and changes in DNA methylation may play a role in the relationship between ALAN exposure and LDL-C control.
Simplified
BACKGROUND: Outdoor artificial light at night () exposure interferes with sleep-wake cycles, leading to sleep disorders, and disrupts metabolic processes, which are closely interconnected. Disruptions in circadian rhythms caused by ALAN may indirectly contribute to metabolic dysregulation, especially in vulnerable populations such as patients with intracranial artery atherosclerotic stenosis (). This study aimed to evaluate the relationship between outdoor ALAN exposure and low-density lipoprotein cholesterol () control in ICAS patients, and to investigate the underlying mechanisms.
METHODS: We investigated the relationship between outdoor ALAN exposure and LDL-C control in ICAS patients, estimating residential ALAN levels using satellite images. Sleep quality was assessed using validated questionnaires, and generalized additive models were applied to examine the association between ALAN and LDL-C control. Mechanistic insights were explored through animal-based untargeted metabolomics and DNA methylation analyses.
RESULTS: A total of 1010 ICAS patients were included, of whom 32 were classified as having poor LDL-C control after three months of management. We found a significant association between outdoor ALAN intensity and poorer LDL-C (control odds ratio = 1.02, 95% CI 1.00, 1.05 per 1 nW/cm/srincrease). Sensitivity analyses verified the stability of this association. Metabolic profiling reveals ALAN may regulate lipid metabolism by affecting ATP-binding cassette (ABC) transporter proteins. Additionally, dim ALAN treatment promoted global hypomethylation in mice, while melatonin treatment partially counteracted these effects without reducing the stress response. -2 -1
CONCLUSION: Increasing ALAN intensity surrounding residences was associated with poorer LDL-C control in ICAS patients, potentially mediated by circadian rhythm disruptions, global methylation levels, and ABC transporter protein expression. These findings suggest that managing urban outdoor lighting could serve as a potential strategy to reduce the public health burden of cerebrovascular and metabolic diseases.
Key numbers
1.02
Increase in Odds of Poor Control
Odds ratio for control status per 1 nW/cm/sr increase in exposure
86%
Global Methylation Reduction
Percentage decrease in global methylation levels in dLAN-exposed mice compared to controls
1010
Patient Cohort Size
Total number of patients included in the study
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Declarations. Ethics approval and consent to participate: This study, involving human participants, was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital of Soochow University ((2024) Ethics Approval No. 262), while the study involving animals was reviewed and approved by the Institutional Review Board of the Fourth Affiliated Hospital of Soochow University ((2024) Ethics Approval No. 241030). The experiments comply with the current laws of the country in which they were performed. The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Competing interests: The authors declare no competing interests.
