December 26, 2018Arteriosclerosis Thrombosis and Vascular Biology104 citationsOpen Access
View Full PaperCholesterol Mass Efflux Capacity, Incident Cardiovascular Disease, and Progression of Carotid Plaque
Structured PICO
Is higher HDL-mediated cholesterol mass efflux capacity associated with reduced incident cardiovascular disease and carotid plaque progression?
P
Population
1,744 adults aged 45 to 84 years from the Multi-Ethnic Study of Atherosclerosis (MESA), comprising Cohort 1 (465 incident cardiovascular disease cases and 465 age- and sex-matched controls) and Cohort 2 (407 cases with carotid plaque progression and 407 matched controls).
I
Intervention
Higher HDL-mediated cholesterol mass efflux capacity (CMEC) level (measured as a continuous exposure)
O
Outcome
Incident cardiovascular disease events (Cohort 1) and progression of carotid plaque measured by ultrasonography (Cohort 2)hard clinical
Higher HDL-mediated cholesterol mass efflux capacity is associated with a lower risk of incident coronary heart disease but paradoxically higher odds of carotid plaque progression.
Abstract
Objective- To assess the role of HDL (high-density lipoprotein)-mediated cholesterol mass efflux capacity (CMEC) in incident cardiovascular disease and carotid plaque progression. Approach and Results- We measured CMEC in 2 cohorts aged 45 to 84 years at baseline derived from the MESA (Multi-Ethnic Study of Atherosclerosis). Cohort 1 comprised 465 cases with incident cardiovascular disease events during 10 years of follow-up and 465 age- and sex-matched controls; cohort 2 comprised 407 cases with progression of carotid plaque measured by ultrasonography at 2 exams >10 years and 407 similarly matched controls. Covariates and outcome events were ascertained according to the MESA protocol. CMEC level was modestly correlated with HDL cholesterol ( R=0.13; P<0.001) but was not associated with age, sex, race/ethnicity, body mass index, diabetes mellitus, alcohol use, smoking status, or statin use. Higher CMEC level was significantly associated with lower odds of cardiovascular disease (odds ratio, 0.82 per SD of CMEC 95% CI, 0.69-0.98; P=0.031 in the fully adjusted model) in cohort 1 but higher odds of carotid plaque progression (odds ratio, 1.24 per SD of CMEC 95% CI, 1.04-1.48; P=0.018 in the fully adjusted model) in cohort 2 but without dose-response effect. In subgroup analysis within cohort 1, higher CMEC was associated with lower risk of incident coronary heart disease events (odds ratio, 0.72 per SD of CMEC (95% CI, 0.5-0.91; P=0.007) while no association was found with stroke events. Conclusions- These findings support a role for HDL-mediated cholesterol efflux in an atheroprotective mechanism for coronary heart disease but not stroke.