Cholesterol efflux capacity in coronary artery disease: a meta-analysis

To quantitatively analyze the association between cholesterol efflux capacity (CEC) and the risk and prognosis of coronary artery disease (CAD).

A systematic search of electronic databases for studies published until September 2019 was performed. Cohorts, case-control studies, and randomized controlled trials that examined the effect of CEC on the risk and prognosis of CAD were included.

Eighteen studies with 12 685 subjects met our inclusion criteria. Among them, 14 studies reported the CEC in non-CAD and CAD groups, and eight studies reported the association between CEC and risk of CAD. Four studies reported the prognosis of stable CAD or acute coronary syndrome (ACS). In the pooled analyses, significantly decreased CEC was found in patients with stable CAD as compared with those without CAD. Decreased CEC was also present in subgroup in patients with ACS. High CEC was significantly associated with decreased risk of CAD [odds ratio (OR) = 0.65, 95% confidence interval (CI): 0.55-0.75, P < 0.001]. High CEC predicted lower all-cause mortality (OR = 0.39, 95% CI: 0.20-0.77, P = 0.007) and cardiovascular mortality (OR = 0.34, 95% CI: 0.13-0.90, P = 0.03) in patients with CAD. However, CEC failed to predict the occurrence of stroke and myocardial infraction in patients with CAD.

Decreased CEC is an independent risk factor for CAD, and it predicts all-cause and cardiovascular mortality in patients with CAD.