title: Cholesterol efflux capacity of high-density lipoprotein correlates with survival and allograft vasculopathy in cardiac transplant recipients.
abstract: Cardiac allograft vasculopathy (CAV) is a major cause of mortality after cardiac transplantation. High-density lipoprotein (HDL) cholesterol efflux capacity (CEC) is inversely associated with coronary artery disease. In 2 independent studies, we tested the hypothesis that reduced CEC is associated with mortality and disease progression in CAV.
  
  
  
  We tested the relationship between CEC and survival in a cohort of patients with CAV (n = 35). To determine whether reduced CEC is associated with CAV progression, we utilized samples from the Clinical Trials in Organ Transplantation 05 (CTOT05) study to determine the association between CEC and CAV progression and status at 1 year (n = 81), as assessed by average change in maximal intimal thickness (MIT) on intravascular ultrasound.
  
  
  
  Multivariable Cox proportional hazard models demonstrated that higher levels of CEC were associated with improved survival (hazard ratio 0.26, 95% confidence interval 0.11 to 0.63) per standard deviation CEC, p = 0.002). Patients who developed CAV had reduced CEC at baseline and 1-year post-transplant. We observed a significant association between pre-transplant CEC and the average change in MIT, particularly among patients who developed CAV at 1 year (β = -0.59, p = 0.02, R2= 0.35).
  
  
  
  Reduced CEC is associated with disease progression and mortality in CAV patients. These findings suggest the hypothesis that interventions to increase CEC may be useful in cardiac transplant patients for prevention or treatment of CAV.
authors: Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA. Electronic address: ali.javaheri@wustl.edu.
authors: Ali
authors: A
authors: Javaheri
authors: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Maria
authors: M
authors: Molina
authors: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Payman
authors: P
authors: Zamani
authors: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Amrith
authors: A
authors: Rodrigues
authors: Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors: Eric
authors: E
authors: Novak
authors: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Susan
authors: S
authors: Chambers
authors: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Patricia
authors: P
authors: Stutman
authors: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Wilhelmina
authors: W
authors: Maslanek
authors: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Mary
authors: M
authors: Williams
authors: Division of Cardiology, Ohio State University, Columbus, Ohio, USA.
authors: Scott M
authors: SM
authors: Lilly
authors: Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Peter
authors: P
authors: Heeger
authors: Brigham & Women׳s Hospital, Harvard University, Boston, Massachusetts, USA; Department of Medicine and Immunology, American University of Beirut, Beirut, Lebanon.
authors: Mohamed H
authors: MH
authors: Sayegh
authors: Brigham & Women׳s Hospital, Harvard University, Boston, Massachusetts, USA.
authors: Anil
authors: A
authors: Chandraker
authors: Children's Hospital Boston, Boston, Massachusetts, USA.
authors: David M
authors: DM
authors: Briscoe
authors: Children's Hospital Boston, Boston, Massachusetts, USA.
authors: Kevin P
authors: KP
authors: Daly
authors: Cleveland Clinic, Cleveland, Ohio, USA.
authors: Randall
authors: R
authors: Starling
authors: Department of Biostatistics, Rho Federal Systems Division, Rho, Inc., Chapel Hill, North Carolina, USA.
authors: David
authors: D
authors: Ikle
authors: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Jason
authors: J
authors: Christie
authors: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: J Eduardo
authors: JE
authors: Rame
authors: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Lee R
authors: LR
authors: Goldberg
authors: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Jeffrey
authors: J
authors: Billheimer
authors: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Daniel J
authors: DJ
authors: Rader
mesh_terms: D064591:Allografts; D015415:Biomarkers / Q000097:blood; D002784:Cholesterol / Q000097:blood*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D018450:Disease Progression; D014943:Global Health; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood*; D055031:Primary Graft Dysfunction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D015996:Survival Rate / Q000639:trends; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers; D008075:Lipoproteins, HDL; D002784:Cholesterol
keywords: cardiac allograft vasculopathy; cholesterol efflux capacity; high-density lipoprotein; survival; transplantation