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Cholesterol Efflux Assay
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Cholesterol Uptake Capacity as a Prognostic Marker of Cardiovascular Events for Patients with Coronary Artery Disease

Yusuke Yoshikawa1, Ryuji Toh2, Katsuhiro Murakami3

  • 1Department of Biostatistics, National Cerebral and Cardiovascular Center.

Journal of Atherosclerosis and Thrombosis
|March 30, 2025
PubMed

Insights

Low cholesterol uptake capacity (CUC) in patients with coronary artery disease (CAD) predicts a higher risk of future atherosclerotic cardiovascular disease (ASCVD) events after revascularization.

Area of Science:

  • Cardiovascular Medicine
  • Biochemistry
  • Clinical Pathology

Background:

  • Cholesterol uptake capacity (CUC) is a functional measure of high-density lipoprotein (HDL).
  • HDL-CUC is gaining attention for its role in atherosclerotic cardiovascular disease (ASCVD) risk stratification.
  • Assessing HDL functionality offers a novel approach to cardiovascular risk assessment.

Purpose of the Study:

  • To evaluate the predictive value of HDL-CUC for long-term ASCVD events in patients with coronary artery disease (CAD).
  • To determine if HDL-CUC can refine risk stratification in post-revascularization CAD patients.

Main Methods:

  • Retrospective observational study of 503 patients with CAD undergoing coronary revascularization.
  • Blood samples collected within three months of index revascularization.
  • CUC assayed using an automated system; patients stratified into tertiles of CUC.
  • Primary outcome: composite of all-cause death, myocardial infarction, stroke, and peripheral artery disease.

Main Results:

  • A total of 29 ASCVD events occurred over a median follow-up of 2.8 years.
  • Patients in the lowest CUC tertile had a significantly higher risk of ASCVD events compared to the highest CUC tertile (3-year incidence: 8.8% vs. 4.0%, p=0.046).
  • Adjusted analysis confirmed that low CUC remained a significant predictor of ASCVD events (HR 3.17, p=0.040).

Conclusions:

  • Low HDL-CUC is associated with an increased risk of ASCVD events in CAD patients post-coronary revascularization.
  • HDL functionality, as measured by CUC, is a valuable tool for predicting ASCVD risk in this population.
  • CUC assessment may enhance clinical decision-making for cardiovascular risk management in CAD patients.
Abstract

Keywords:
Cholesterol efflux capacityCholesterol uptake capacityCoronary artery diseaseFunctionality of high-density lipoproteinHigh-density lipoproteinSecondary prevention

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