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Published on: October 12, 2017
Association between the High-density Lipoprotein Cholesterol Efflux Capacity and the Long-term Prognosis in Patients
Itaru Hisauchi1, Tetsuya Ishikawa1, Kota Yamada1
1Department of Cardiology, Dokkyo Medical University Saitama Medical Center.
Insights
High-density lipoprotein cholesterol efflux capacity (HDL-CEC) measured during coronary angiography predicts fewer major adverse cardiovascular events (MACE) in coronary artery disease (CAD) patients. Higher HDL-CEC is linked to significantly reduced risks of cardiovascular outcomes and mortality.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Preventive Cardiology
Background:
- Coronary artery disease (CAD) poses a significant global health burden.
- High-density lipoprotein cholesterol (HDL-C) plays a protective role in cardiovascular health.
- Cholesterol efflux capacity (CEC), a functional measure of HDL, is increasingly recognized for its clinical relevance.
Purpose of the Study:
- To systematically review and meta-analyze the prognostic value of baseline HDL-CEC in predicting major adverse cardiovascular events (MACE) in patients with CAD.
- To determine if HDL-CEC measured at the time of coronary angiography (CAG) can serve as a reliable prognostic marker.
Main Methods:
- A systematic search of MEDLINE, Cochrane, and Embase databases was conducted up to April 2024.
- Included studies compared MACEs in patients with angiographically defined CAD, comparing higher vs. lower HDL-CEC quartiles.
- Hazard ratios (HRs) for composite cardiovascular outcomes were estimated using a random-effects model, adjusting for confounders.
Main Results:
- Five studies involving 5,725 CAD patients with a mean follow-up of 4.9 years were analyzed.
- Higher HDL-CEC was associated with significantly lower risks for both composite cardiovascular outcomes (Model-1 HR: 0.34, p=0.0005) and outcomes excluding all-cause mortality (Model-2 HR: 0.28, p=0.0013).
- Significant heterogeneity was observed across studies (I² > 59%).
Conclusions:
- This meta-analysis provides the first evidence of a significant inverse relationship between baseline HDL-CEC and long-term MACE in CAD patients.
- HDL-CEC measured during CAG is a valuable prognostic marker for cardiovascular risk stratification in CAD.
- These findings support the clinical utility of assessing HDL-CEC for personalized cardiovascular risk management.
Aim:
We aimed to determine whether baseline high-density lipoprotein (HDL) cholesterol efflux capacity (CEC) at the time of coronary angiography (CAG) could serve as a prognostic marker for future major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) through a systematic review and meta-analysis.
Methods:
The MEDLINE, Cochrane, and Embase databases were used for data collection. As of April 2024, 2,871 studies have been identified. Clinical studies comparing MACEs over an observational interval exceeding 12 months in patients with angiographically defined CAD with estimated hazard ratios (HRs) of MACEs in the higher or top-quartile HDL-CEC (H-HDL-CEC) group compared with the lower or bottom-quartile HDL-CEC (L-HDL-CEC) group, after adjusting for six confounding variables, including HDL-C, were included. HRs of 1) overall cardiovascular outcomes, composite of cardiovascular mortality, myocardial infarction, any coronary revascularization, and all-cause mortality (Model-1), and 2) cardiovascular outcomes excluding all-cause mortality from Model-1 (Model-2), compared between the L-HDL-CEC and H-HDL-CEC groups, were estimated using a random-effects model, respectively.
Results:
In five studies, 5,725 patients with CAD with a mean observational interval of 4.9 years were included. The H-HDL-CEC group had significantly lower risks for both estimates (Model-1: HR: 0.34, 95% confidence interval [CI]: 0.18-0.63 [p=0.0005], and I2=59.8% [p=0.04]; Model-2: HR: 0.28, 95% CI: 0.13-0.60 [p=0.0013], and I2=64% [p=0.04]).
Conclusion:
This is the first systematic review and meta-analysis to demonstrate a significant inverse relationship between the baseline HDL-CECs on CAG and long-term MACEs in CAD patients.
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