Dallas Heart Study: HDL Efflux Capacity and CV Events

Cholesterol efflux capacity, defined as the ability of high-density lipoprotein (HDL) cholesterol to accept cholesterol from macrophages, is inversely associated with the incidence of cardiovascular events, according to results of the Dallas Heart Study presented Nov. 18 at AHA 2014 and simultaneously published in the New England Journal of Medicine.

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The study, led by Anand Rohatgi, MD, FACC, investigated the association of cholesterol efflux capacity with incident atherosclerotic cardiovascular disease outcomes. The participants – originally 2,924 adults in total, cut down to 2,416 because of missing covariates and incomplete follow-ups – were drawn from the Dallas Heart Study, a multiethnic, population-based cohort study, and were free from cardiovascular disease. The researchers measured HDL cholesterol levels, HDL particle concentration and cholesterol efflux capacity in the patients at baseline and again in 9.4 years on average. The primary endpoint of the study was reported as atherosclerotic cardiovascular disease, including a first nonfatal myocardial infarction, nonfatal stroke, coronary revascularization or death from cardiovascular causes.

The study showed that cholesterol efflux capacity was significantly lower in blacks than in non-blacks, but similar in men in women. When compared to HDL cholesterol levels, cholesterol efflux capacity showed minimal associations with traditional risk factors, lipoproteins, adiposity or insulin resistance. A primary atherosclerotic cardiovascular disease event was seen in only 132 patients. Researchers found that “there was a 67 percent reduction in cardiovascular risk in the highest quartile of cholesterol efflux capacity versus the lowest quartile.”

The authors note that “cholesterol efflux capacity, as a measure of reverse cholesterol transport, may provide the ability to interrogate key mechanisms related to cardiovascular disease in humans.”

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Lipid Metabolism, Nonstatins

Keywords: Myocardial Infarction, Stroke, Follow-Up Studies, Atherosclerosis, Macrophages, Adiposity, Risk Factors, Cholesterol, HDL, Insulin Resistance

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