title: High-density lipoprotein cholesterol efflux capacity as a relevant predictor of atherosclerotic coronary disease.
abstract: BACKGROUND
  We examined the clinical relevance of high-density lipoprotein cholesterol (HDL-C) efflux capacity from macrophage (cholesterol efflux capacity) as a predictor of atherosclerotic coronary artery disease (CAD) in comparison with that of conventional coronary and lipid risk variables in Japanese daily practice.
  
  
  RESULTS
  Fasting blood sampling, including 6 routinely measured dyslipidemia-related variables, was performed at the time of coronary angiography (CAG) or multi-slice coronary computed tomography (MSCT) between January 2011 and January 2013. CAD, defined as native coronary atherosclerosis stenosis >50% by CAG or MSCT, was identified in 182 patients (CAD group), but not in 72 patients (non-CAD group). Cholesterol efflux capacity, measured using a cell-based efflux system in (3)[H]-cholesterol-labeled J774 macrophages in apolipoprotein B-depleted plasma, was significantly impaired in the CAD group compared with the non-CAD group (0.86 ± 0.26 vs. 1.02 ± 0.38; p = 0.001). After adjusting 15 patient and dyslipidemia-related variables using a propensity score matching analysis produced 55 patients in each arm, cholesterol efflux capacity in the CAD group remained to be significant compared with the non-CAD group (0.83 ± 0.24 vs. 0.97 ± 0.36; p = 0.019). Stepwise logistic regression analysis using a backward method after the baseline adjustment showed that cholesterol efflux capacity (odds ratio [OR]: 0.23; 95% confidence interval [CI]: 0.056-0.91; p = 0.037) was the single predictor of CAD, while other variables including HDL-C (p = 0.088) and apolipoprotein (apo) A-I (p = 0.681) were removed owing to those insignificance. The area under the receiver operating characteristic curve after the baseline adjustment was 0.67 (95% CI: 0.51-0.73, p = 0.048 by Hosmer-Lemeshow goodness-of-fit statistics).
  
  
  CONCLUSIONS
  The present observational study conducted under daily clinical practice confirmed that cholesterol efflux capacity is a clinically relevant predictor of CAD among the conventional coronary risk factors and dyslipidemia-related variables.
authors.affiliation: Division of Cardiology, Saitama Cardiovascular Respiratory Center, Kumagaya, Saitama, Japan. Electronic address: tetsuya50ishikawa@gmail.com.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Division of Anti-aging and Vascular Medicine, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ayaori
authors.affiliation: Division of Anti-aging and Vascular Medicine, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Harumi
authors.initials: H
authors.lastname: Uto-Kondo
authors.affiliation: Division of Cardiology, Saitama Cardiovascular Respiratory Center, Kumagaya, Saitama, Japan.
authors.forename: Takatomo
authors.initials: T
authors.lastname: Nakajima
authors.affiliation: Division of Cardiology, Saitama Cardiovascular Respiratory Center, Kumagaya, Saitama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Mutoh
authors.affiliation: Division of Anti-aging and Vascular Medicine, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Ikewaki
mesh_terms: D000368:Aged; D000818:Animals; D016632:Apolipoprotein A-I / Q000097:blood; D053299:Apolipoprotein B-100 / Q000097:blood; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002460:Cell Line; D016009:Chi-Square Distribution; D008076:Cholesterol, HDL / Q000097:blood*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D023921:Coronary Stenosis / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D050171:Dyslipidemias / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008264:Macrophages / Q000378:metabolism*; D008297:Male; D051379:Mice; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D016017:Odds Ratio; D011237:Predictive Value of Tests; D057216:Propensity Score; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: C505693:APOA1 protein, human; C569471:APOB protein, human; D016632:Apolipoprotein A-I; D053299:Apolipoprotein B-100; D015415:Biomarkers; D008076:Cholesterol, HDL
keywords: Coronary artery disease; High-density lipoprotein cholesterol efflux capacity; Lipid disorder; Low-density lipoprotein cholesterol; Propensity score matching analysis