Quantity, function and genetics of HDL as an indicator of CHD.

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Study 1 : Quantity and Function of High Density Lipoprotein as an Indicator of CoronaryAtherosclerosis Background Most of the cholesterol esterification in plasma takes place in the high density lipoprotein (HDL) fraction. The rate of cholesterol esterification in low density (LDL)-and very low density lipoprotein (VLDL)-depleted plasma, which can be expressed as the fractional esterification rate in HDL (FER_<HDL>), and which reflects the reactivity of HDL to lecithin : cholesterol acyltransferase (LCAT), is an important functional assay of HDL.The aim of the present study was to investigate the role of this functional assay of HDL in coronary atheroscierosis (CA) and to establish the best indicator for CA through the combination of quantitative and functional assays of HDL while considering conventional risk factors. Mehods and Results in a study of case and control subjects [with (CA+, n=185)/without (CA-, n=74) angiographically proven CA], we examined the association between CA and … More serum levels of HDL-cholesterol (C), HDL subfraction-C,apolipoproteins, lipoprotein (a), and FER_<HDL>. Age-and sex-adjusted values of HDL-C,HLD2-C,HLD3-C,apo A-I,and apo A-II were lower and those of lipoprotein (a) and FER_<HDL> were higher in CA+ patints than in CA-patients, but these variables were not associated with the extent of stenosis. A close negative correlation was observed between FER_<HDL> and HDL-C in both CA+ and CA- patients, but a covariance analysis indicated significant interaction between the regression line of FER_<HDL> vs. HDL-C for CA+ patients and that for CA-oatients, suggesting an altered relationship between the quantity and function of HDL in CA+ patients. A logistic regression analysis indicated that an increased odds ratio (relative risk for CA) was associated with increasing values of FER_<HDL>/HDL-C.A three-dimensional analysis of the odds ratio and values of FER_<HDL> and HDL-C indicated that patients with the highest FER_<HDL>/HDL-C value (0.68) had the highest odds ratio (12.6), but patients who had the lowest odds ratio (1.00) were those with high HDL-C and high FER_<HDL> values. The odds ratio was>10 times higher in patients with low HDL-C and middle or high FER_<HDL> values and 2.3 times higher in patients with low HDL-C and low FER_<HDL> values than in patients with high HDL-C and FER_<HDL> values, which suggests that high values of FER_<HDL> play an important role in CA,especially when HDL-C is low. Conclusion The combination of a functional assay of HDL (FER_<HDL>) with a quantitative assay of HDL (HDL-C) can be a potent indicator for caronary atherosclerosis. Less