Patients with better HDL function, or cholesterol efflux capacity, were at reduced risk for developing CHD compared with those with poorer function, independent of other CV risk factors, according to results published in The Lancet Diabetes & Endocrinology.
Danish Saleheen, PhD, and colleagues evaluated cholesterol efflux capacity in a nested case-control sample of patients enrolled in the prospective EPIC-Norfolk study, including 1,745 patients who developed incident CHD and 1,749 CVD-free controls. All participants were aged 40 to 79 years and had been originally assessed between 1993 and 1997, with follow-up until 2009.
After adjustment for age and sex, patients who developed CHD had significantly lower cholesterol efflux capacity than controls (mean, 1.17 vs. 1.14; P = .005). Among controls, the researchers observed positive correlations between cholesterol efflux capacity and concentrations of both HDL (r = 0.4; P < .0001) and apolipoprotein A-I (r = 0.22; P < .0001), as well as consumption of alcohol (r = 0.12; P < .0001). They also noted an inverse correlation between efflux capacity and type 2 diabetes (r = –0.18; P < .0001).
Patients in the top tertile for efflux capacity were at reduced risk for CHD compared with those in the bottom tertile, after adjustment for age, sex and batch number (OR = 0.56; 95% CI, 0.46-0.62). This association persisted after progressive adjustment for CV risk factors.
Multivariable analysis indicated a significantly reduced risk for incident CHD with increased efflux capacity (OR = 0.8; 95% CI, 0.7-0.9 per standard deviation change to capacity). Concentrations of HDL and ApoA-I were significantly and adversely associated with CHD risk, but these associations were attenuated after adjustment for cholesterol efflux capacity.
“This is a definitive finding that HDL function, even in people who are still relatively young and healthy, does predict later heart disease events, which implies that therapies that boost HDL function might reduce risk,” researcher Daniel J. Rader, MD, director of the preventive cardiovascular medicine and lipid clinic at Penn Medicine, Philadelphia, said in a press release.
The researchers called for further study to determine the cause of the association between cholesterol efflux capacity and CHD, and they wrote that if a causal relationship exists, interventions targeting efflux capacity may be a new treatment option for reducing CHD risk. – by Adam Taliercio
Disclosure: Rader reports being a founder of VascularStrategies, which performs HDL function assays. Another reported financial relationships with Aegerion, Amgen, AstraZeneca, AtheroNova, Boehringer Ingelheim, Catabasis, Cerenis, CSL Behring, Dezima Pharmaceuticals, Eli Lilly, Esperion, Genzyme, Kowa, The Medicines Company, Merck, Novartis, Omthera, Pronova, Regeneron, Sanofi, UniQure and Vascular Biogenics.