Key result
Lower cholesterol efflux capacity is linked to higher cardiovascular mortality independent of HDL levels.
Why the study?
Raising HDL-C has not uniformly reduced CAD, suggesting cellular cholesterol efflux mediated by HDL may be a more important factor.
Does lower cholesterol efflux capacity predict cardiovascular mortality in patients referred for coronary angiography?
Cohort (n=2,468)
Does lower cholesterol efflux capacity predict cardiovascular mortality in patients referred for coronary angiography?
HDL-mediated cholesterol efflux capacity predicts cardiovascular mortality independently of HDL cholesterol levels, suggesting that HDL function may provide prognostic information beyond HDL concentration.
(1) Background and Aims: Efforts to reduce coronary artery disease (CAD) by raising high-density lipoprotein (HDL) cholesterol (HDL-C) have not been uniformly successful. A more important factor than HDL-C may be cellular cholesterol efflux mediated by HDL, which has been shown to be associated with CAD. In this report, we analyzed the influence of cardiovascular biomarkers and risk factors on cholesterol efflux in a prospective observational study of patients referred to coronary angiography. (2) Methods: HDL-mediated efflux capacity was determined for 2468 participants of the Ludwigshafen Risk and Cardiovascular Health (LURIC) study who were referred to coronary angiography at baseline between 1997 and 2000. Median follow-up time was 9.9 years. Primary and secondary endpoints were cardiovascular and all-cause mortality, respectively. (3) Results: Cholesterol efflux strongly correlated with HDL-related markers including HDL cholesterol, HDL phospholipids, and apolipoproteins AI and AII, as well as HDL particle concentration, which was not seen for low density lipoprotein (LDL) markers including LDL cholesterol and apoB. Cholesterol efflux was associated negatively with C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), and serum amyloid A. Cardiovascular mortality was higher in patients in the lowest cholesterol efflux quartile. This association was weakened, but not fully abolished, after adjustment for HDL cholesterol. (4) Conclusions: We demonstrate that cholesterol efflux was associated with HDL-composition as well as inflammatory burden in patients referred for coronary angiography, and that this inversely predicts cardiovascular mortality independently of HDL cholesterol.
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Ritsch et al. (2020) conducted a cohort in Patients referred to coronary angiography (n=2,468). Cholesterol efflux capacity vs. Higher cholesterol efflux capacity (upper quartiles) was evaluated on Cardiovascular mortality. Lower cholesterol efflux capacity was associated with higher cardiovascular mortality in patients referred for coronary angiography, independently of HDL cholesterol levels.
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