Cholesterol Efflux Capacity and Its Association With Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis.
Cholesterol Efflux Capacity and Its Association With Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis.
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DOI：
10.3389/fcvm.2021.774418
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发表时间：
2021
影响因子：
3.6
通讯作者：
Gibson CM
中科院分区：
文献类型：
--
作者：
Lee JJ;Chi G;Fitzgerald C;Kazmi SHA;Kalayci A;Korjian S;Duffy D;Shaunik A;Kingwell B;Yeh RW;Bhatt DL;Gibson CM
背景：血清高密度脂蛋白胆固醇（HDL-C）水平与心血管疾病事件呈负相关。然而，新出现的证据表明，这是HDL的功能特性，特别是逆转胆固醇转运，这是介导胆固醇从巨噬细胞中去除和减少斑块脂质含量的关键保护机制。胆固醇流出能力（CEC）测量HDL执行此功能的能力。进行了一项系统综述和荟萃分析，以探讨CEC与心血管不良事件的相关性。研究方法：对所有检查CEC与心血管结局之间关系的研究进行了从开始到2019年9月的Embase、PubMed和Web of Science Core Collection的全面文献综述。主要结局是不良心血管事件，包括动脉粥样硬化性心血管疾病（ASCVD）或死亡率。结果：共纳入20篇试验。与低CEC水平相比，高CEC水平与不良心血管事件风险降低37%相关（粗RR = 0.63; 95%CI，0.52-0.76; P < 0.00001）。CEC每增加一个SD，不良心血管事件的风险降低20%（HR = 0.80; 95% CI，0.66-0.97; P = 0.02）。在调整心血管危险因素、药物和HDL-C水平后，这种关联仍然显著（HR = 0.76; 95%CI，0.63-0.91; P = 0.004）。观察到CEC-终点显著相关（P = 0.024），CEC每增加0.1单位，不良心血管事件风险降低5%（RR = 0.95; 95% CI，0.91-0.99）。结论：较高的CEC与较低的不良心血管结局相关。这些发现需要进一步研究CEC是否仅仅是一种生物标志物或一种机制，可以作为改善临床结局的药物干预。PROSPERO注册号：CRD 42020146681; https://www.crd.york.ac.uk/prospero/。
Background: Serum high-density lipoprotein cholesterol (HDL-C) levels are inversely associated with cardiovascular disease events. Yet, emerging evidence suggests that it is the functional properties of HDL, in particular, reverse cholesterol transport, which is a key protective mechanism mediating cholesterol removal from macrophage cells and reducing plaque lipid content. Cholesterol efflux capacity (CEC) measures the capacity of HDL to perform this function. A systematic review and meta-analysis were conducted to explore the association of CEC and adverse cardiovascular events. Methods: A comprehensive literature review of Embase, PubMed, and Web of Science Core Collection from inception to September 2019 was performed for all studies that examined the association between CEC and cardiovascular outcomes. The primary outcome was adverse cardiovascular events, which were inclusive of atherosclerotic cardiovascular disease (ASCVD) or mortality. Results: A total of 20 trials were included. Compared with low CEC levels, high CEC levels were associated with a 37% lower risk of adverse cardiovascular events (crude RR = 0.63; 95% CI, 0.52–0.76; P < 0.00001). Every SD increase of CEC was associated with a 20% lower risk of adverse cardiovascular events (HR = 0.80; 95% CI, 0.66–0.97; P = 0.02). The association remained significant after adjusting for cardiovascular risk factors, medications, and HDL-C levels (HR = 0.76; 95% CI, 0.63–0.91; P = 0.004). A significant CEC-endpoint relationship was observed (P = 0.024) such that for every 0.1 unit increase in CEC, there was a 5% reduced risk for adverse cardiovascular events (RR = 0.95; 95% CI, 0.91–0.99). Conclusions: Higher CEC is associated with lower adverse cardiovascular outcomes. These findings warrant further research on whether CEC is merely a biomarker or a mechanism that could be targeted as a pharmacologic intervention for improving clinical outcomes. PROSPERO Registration Number: CRD42020146681; https://www.crd.york.ac.uk/prospero/.