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High-Density Lipoprotein Cholesterol Efflux Capacity as a Novel Prognostic Surrogate for Coronary Artery Disease
Itaru Hisauchi1, Tetsuya Ishikawa1, Makoto Ayaori2
1Department of Cardiology, Dokkyo Medical University, Saitama Medical Center.
Insights
High-density lipoprotein cholesterol efflux capacity (CEC) significantly impacts major adverse cardiac events (MACE) in coronary artery disease (CAD) patients. Enhanced CEC levels predict better long-term clinical outcomes in CAD secondary prevention.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Clinical Research
Background:
- Coronary artery disease (CAD) poses significant long-term health risks.
- Secondary prevention strategies are crucial for managing patients with CAD.
- Assessing prognostic markers for CAD is essential for effective patient management.
Purpose of the Study:
- To investigate the association between baseline cholesterol efflux capacity (CEC) and major adverse cardiac events (MACE) in patients with CAD.
- To determine if enhanced CEC serves as a predictor for improved long-term clinical outcomes in CAD secondary prevention.
Main Methods:
- CEC was measured using a (3)[H]-cholesterol-labeled J774 macrophage efflux system.
- Patients with CAD were stratified into impaired (CEC < 1) and enhanced (CEC ≥ 1) groups.
- A Cox proportional hazard model was employed to analyze the impact of enhanced CEC on MACE.
Main Results:
- The incidence of MACE was significantly higher in the impaired CEC group (16.9%) compared to the enhanced CEC group (2.3%).
- Revascularization incidence was a primary driver of MACE differences between the groups.
- Enhanced CEC was identified as a significant predictor of reduced MACE (HR: 0.11, p=0.038).
Conclusions:
- A baseline CEC level ≥ 1 is associated with favorable long-term clinical outcomes in CAD patients.
- CEC demonstrates potential as a valuable prognostic and therapeutic surrogate marker for CAD secondary prevention.
- Measuring CEC may aid in risk stratification and treatment guidance for patients with coronary artery disease.
Aim:
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.
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