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Updated: May 23, 2026
High-Density Lipoprotein-Specific Phospholipid Efflux Assay
Published on: September 30, 2025
The relationship between high-density lipoprotein cholesterol and coronary collateral circulation in patients with
Hasan Kadi1, Huseyin Ozyurt, Koksal Ceyhan
1Department of Cardiology, Gaziosmanpasa University, Tokat, Turkey. drhkadi@gmail.com
Insights
Low high-density lipoprotein cholesterol (HDL-C) is linked to poor coronary collateral circulation (CCC). This study found low HDL-C predicts reduced CCC, highlighting its importance in cardiovascular health.
Area of Science:
- Cardiology
- Vascular Biology
- Biochemistry
Background:
- High-density lipoprotein cholesterol (HDL-C) plays a role in cholesterol efflux from macrophages and possesses anti-inflammatory and endothelium-protective effects.
- Despite coronary artery stenosis being a prerequisite for collateral development, significant variations in coronary collateral circulation (CCC) exist among patients with similar disease severity.
Purpose of the Study:
- To investigate the potential association between HDL-C levels and the development of coronary collateral circulation (CCC).
Main Methods:
- The study included 151 patients with at least one occluded major coronary artery.
- Coronary collateral circulation (CCC) was assessed using Rentrop classification, categorizing patients into poor (grades 0-1) or good (grades 2-3) CCC groups.
- Statistical analyses included t-tests, chi-square tests, and multivariate logistic regression to identify predictors of CCC.
Main Results:
- Patients with poor CCC (n=49) more frequently had a history of myocardial infarction, higher serum triglycerides, and lower HDL-C levels compared to those with good CCC (n=102).
- Multivariate logistic regression identified low HDL-C as a significant predictor of poor CCC (Odds Ratio, 4.3; P < 0.001).
Conclusions:
- A higher frequency of low HDL-C was observed in patients with poor coronary collateral circulation.
- HDL-C levels are a significant predictor of coronary collateral circulation (CCC).
Introduction:
High-density lipoprotein cholesterol (HDL-C) promotes cholesterol efflux from macrophage foam cells in atheroma plaques. In addition, HDL-C has anti-inflammatory and endothelium-protective properties. Despite that the only prerequisite for collateral development is shown to be the degree of coronary artery stenosis, there are significant differences even among patients with a similar degree of coronary artery disease.
Objective:
We designed this study to investigate a possible association between HDL-C and coronary collateral circulation (CCC).
Materials And Methods:
All study participants had at least one occluded major coronary artery. Demographic, clinical, and laboratory data were obtained from patients' medical records. To classify CCC, we used Rentrop classification. The patients were then classified as having poor CCC (Rentrop grades 0-1) or good CCC (Rentrop grades 2-3). We performed t test and the χ test in comparing groups and multivariate logistics regression analysis to determine the predictors of CCC. The study population consisted of 151 patients (mean age, 63.7 ± 9 years; 76.2% male).
Results:
Forty-nine patients had poor CCC and 102 patients had good CCC. The proportion of previous myocardial infarctions, serum triglycerides, and low HDL-C levels were more frequent in the poor CCC group (P = 0.026, P = 0.015, and P < 0.001, respectively). Multivariate logistic regression analysis revealed that low HDL-C is a predictor of CCC (B = 1.456; P < 0.001; odds ratio, 4.3; 95% confidence interval, 1.964-9.369).
Conclusion:
We found that low HDL-C frequency was more frequent in the poor CCC group than the good CCC group, and HDL-C was a predictor of CCC.
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