High-Density Lipoprotein Cholesterol Efflux Capacity as a Novel Prognostic Surrogate for Coronary Artery Disease

Abstract

We examined the impact of baseline high-density lipoprotein cholesterol efflux capacity (CEC) on major cardiac adverse events (MACE) in patients with coronary artery disease (CAD) during a long-term secondary prevention. Method: CEC was measured using a cell-based efflux system in (3)[H]-cholesterol-labeled J774 macrophages in apolipoprotein B-depleted plasma between January 2011 and January 2013. Patients with CAD were divided into 2 groups as a boundary CEC value of 1: 0.19 ≤ CEC 1 (impaired CEC group, mean CEC of 0.76 0.16, n 136), and 1 ≤ CEC ≤ 2.08 (enhanced CEC group, 1.20 0.19, n 44). MACE, comprised the incidence of cardiac death, non-fatal myocardial infarction, and any revascularizations (RV) without restenosis approximately 1 year after vascularization, was retrospectively investigated at September 2019. Impact of enhanced CEC on MACE among 22 variables was examined by applying a Cox proportional hazard model. Result:The frequency of MACE in impaired CEC group (16.9%, mean observational interval of 2111 888 days) was significantly higher than that in enhanced CEC group (2.3%, 2,252 685, p 0.013), largely driven by the significantly higher RV incidence (14.0 % versus 2.3 %, p 0.032). Enhancement of CEC was the significant predictor of MACE (hazard ratio: 0.11; 95% CI: 0.013-0.879; p 0.038). Conclusion:A baseline CEC level of more than 1 in patients with CAD brought favorable long-term clinical outcomes, suggesting that CEC is a useful prognostic and therapeutic surrogate for secondary prevention of CAD.apy of LDL-C 1) . Among the pleiotropic atheroprotective effects of high-density lipoprotein cholesterol (HDL-C), cholesterol efflux from macrophage (cholesterol efflux capacity, CEC) was consistently demonstrated as a negative predictor of CAD, independent of HDL-C and LDL-C levels 2, 3) . In addition, the CEC in asymptomatic healthy subjects predicts the incidence of atherosclerotic cardiovascular events

Cholesterol Efflux Capacity and Cardiovascular Disease: The Ludwigshafen Risk and Cardiovascular Health (LURIC) Study

“…However, we believe that any such changes would not have produced a major bias. Our data are in good agreement with recent data of a secondary prevention study suggesting that cholesterol efflux capacity is a useful prognostic and therapeutic surrogate for secondary prevention of CAD [ 21 ].…”

Effects of Dietary Education Program for the Japan Diet on Cholesterol Efflux Capacity: A Randomized Controlled Trial

“…TG was reported to be positively associated with CEC in subjects with HDL-C 40 mg/dL but there was no association in subjects with HDL-C ≥ 40 mg/dL in the PHINOX study 24) . On the other hand, TG did not differ between groups of Japanese coronary artery disease patients with impaired versus enhanced CEC 25) and were not related in control participants in the EPIC-Norfolk study 26) . ABCA1-CEC, which is calculated as ABCA1 up-regulated CEC minus non up-regulated CEC, was higher in patients with TG ≥ 300 mg/dL than in healthy controls 27) .…”

Impact of Dietary Lipids on the Reverse Cholesterol Transport: What We Learned from Animal Studies

“…From an experimental point of view, numerous methods are available for the quantification of RCT in vitro, either in animal models or in humans [ 14 , 15 ]. Indeed, the evaluation of the in vitro cholesterol efflux capacity of HDL collected from human subjects, measuring the extent of the first step of RCT, has been proposed as a valuable biomarker of cardiovascular risk [ 16 , 17 , 18 , 19 ]. Conversely, other studies revealed no association between HDL efflux capacity and cardiovascular outcomes [ 20 , 21 , 22 , 23 ], challenging the application of this method in the clinical setting.…”