title: Association of Plasma 7-Ketocholesterol With Cardiovascular Outcomes and Total Mortality in Patients With Coronary Artery Disease.
abstract: BACKGROUND
  7-Ketocholesterol (7-KC), a form of cholesterol oxidation product, plays an essential role in the atherogenesis in animal models.
  
  
  OBJECTIVE
  We sought to determine the association of circulating 7-KC with clinical cardiovascular outcomes and total mortality in patients with stable coronary artery disease.
  
  
  RESULTS
  We measured the plasma 7-KC levels by high-performance liquid chromatography in a prospective cohort study of 1016 patients (mean age, 63.2 years; male 61.1%) with stable coronary artery disease who were recruited from December 2008 to December 2011 and followed up for a median of 4.6 years. We adjudicated myocardial infarction, hospitalization of heart failure, cardiovascular death, all-cause death, and composite end points of myocardial infarction/heart failure/death by review of medical records and death certificates. We used multivariable Cox proportional hazards analysis to compare the incidence rate of cardiovascular events and all-cause death according to the quartile of the plasma 7-KC. During the median 4.6 years follow-up, totally 221 participants (21.8%) experienced a cardiovascular event or death. The adjusted risk of the composite end points was higher in the highest 7-KC quartile than in the lowest quartile (hazard ratio, 1.76; 95% confidence interval, 1.42-2.21;P<0.001). After adjustment for demographic and clinical variables and other biomarkers, including high-sensitivity C-reactive protein and NT-proBNP (N-terminal pro-B-type natriuretic peptide), 1 SD increase in the 7-KC level remained associated with a 36% higher rate of composite outcomes (hazard ratio, 1.36; 95% confidence interval, 1.22-1.48;P=0.007). Plasma 7-KC clearly improved various model performance measures, including C statistics, integrated discrimination, and category-free net reclassification.
  
  
  CONCLUSIONS
  High 7-KC levels are associated with increased risk of cardiovascular events, total death, and composite outcomes in patients with stable coronary artery disease.
authors.affiliation: From the Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J.); Department of Nutrition, School of Public Health, Sun Yat-sen University (Northern Campus), Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J., M.X.); Department of Clinical Nutrition, Guangdong General Hospital, Guangzhou, China (D.W.); and Department of Clinical Nutrition, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China (C.C.).
authors.forename: Jiayi
authors.initials: J
authors.lastname: Song
authors.affiliation: From the Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J.); Department of Nutrition, School of Public Health, Sun Yat-sen University (Northern Campus), Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J., M.X.); Department of Clinical Nutrition, Guangdong General Hospital, Guangzhou, China (D.W.); and Department of Clinical Nutrition, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China (C.C.).
authors.forename: Duan
authors.initials: D
authors.lastname: Wang
authors.affiliation: From the Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J.); Department of Nutrition, School of Public Health, Sun Yat-sen University (Northern Campus), Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J., M.X.); Department of Clinical Nutrition, Guangdong General Hospital, Guangzhou, China (D.W.); and Department of Clinical Nutrition, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China (C.C.).
authors.forename: Hongen
authors.initials: H
authors.lastname: Chen
authors.affiliation: From the Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J.); Department of Nutrition, School of Public Health, Sun Yat-sen University (Northern Campus), Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J., M.X.); Department of Clinical Nutrition, Guangdong General Hospital, Guangzhou, China (D.W.); and Department of Clinical Nutrition, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China (C.C.).
authors.forename: Xiuwei
authors.initials: X
authors.lastname: Huang
authors.affiliation: From the Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J.); Department of Nutrition, School of Public Health, Sun Yat-sen University (Northern Campus), Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J., M.X.); Department of Clinical Nutrition, Guangdong General Hospital, Guangzhou, China (D.W.); and Department of Clinical Nutrition, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China (C.C.).
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhong
authors.affiliation: From the Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J.); Department of Nutrition, School of Public Health, Sun Yat-sen University (Northern Campus), Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J., M.X.); Department of Clinical Nutrition, Guangdong General Hospital, Guangzhou, China (D.W.); and Department of Clinical Nutrition, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China (C.C.).
authors.forename: Nan
authors.initials: N
authors.lastname: Jiang
authors.affiliation: From the Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J.); Department of Nutrition, School of Public Health, Sun Yat-sen University (Northern Campus), Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J., M.X.); Department of Clinical Nutrition, Guangdong General Hospital, Guangzhou, China (D.W.); and Department of Clinical Nutrition, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China (C.C.).
authors.forename: Chaogang
authors.initials: C
authors.lastname: Chen
authors.affiliation: From the Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J.); Department of Nutrition, School of Public Health, Sun Yat-sen University (Northern Campus), Guangzhou, Guangdong Province, China (J.S., H.C., X.H., Y.Z., N.J., M.X.); Department of Clinical Nutrition, Guangdong General Hospital, Guangzhou, China (D.W.); and Department of Clinical Nutrition, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China (C.C.). xiamin@mail.sysu.edu.cn.
authors.forename: Min
authors.initials: M
authors.lastname: Xia
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007653:Ketocholesterols / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D007653:Ketocholesterols; C003001:7-ketocholesterol
keywords: atherosclerosis; cholesterol; coronary artery disease; death; risk factors