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Meta-Analysis
. 2017 Nov 10;16(1):212.
doi: 10.1186/s12944-017-0604-5.

High-density lipoprotein cholesterol efflux capacity is inversely associated with cardiovascular risk: a systematic review and meta-analysis

Chengfeng Qiu  1   2   3 , Xiang Zhao  4 , Quan Zhou  5 , Zhen Zhang  6   7
Affiliations
Meta-Analysis

High-density lipoprotein cholesterol efflux capacity is inversely associated with cardiovascular risk: a systematic review and meta-analysis

Chengfeng Qiu et al. Lipids Health Dis. .

Abstract

Background: A low plasma level of high-density lipoprotein (HDL) cholesterol (HDL-C) is associated with cardiovascular risk. A key cardioprotective property of HDL is cholesterol efflux capacity (CEC), the ability of HDL to accept cholesterol from macrophages. In this study, we aimed to identify the predictive value of CEC for cardiovascular risk.

Methods: The relative risks (RRs) and 95% confidence intervals (CIs) were pooled to analyze the association between CEC and the incidence of cardiovascular events and all-cause mortality. The odds ratios (ORs) and 95% CIs were pooled to estimate the association of CEC and the prevalence of cardiovascular events.

Results: A total of 15 studies were included. Results showed that the highest CEC was significantly associated with a reduced risk of cardiovascular events incidents compared to the lowest CEC (RR, 0.56; 95% CI, 0.37 to 0.85; I 2, 89%); the pooled RR of cardiovascular risk for per unit SD increase was 0.87 (95% CI, 0.73 to 1.04; I 2, 67%). Dose-response curve indicated that cardiovascular risk decreased by 39% (RR, 0.61; 95% CI, 0.51 to 0.74) for per unit CEC increase. Similarly, an inverse association was observed between CEC and the prevalence of cardiovascular events (highest vs. lowest, OR, 0.30; 95% CI, 0.17 to 0.5; I 2 = 63%; per unit SD increase, OR, 0.94; 95% CI, 0.90 to 0.98; I 2 = 71%). However, based on the current data, CEC was not significantly associated with all-cause mortality.

Conclusions: Findings from this meta-analysis suggest that HDL-mediated CEC is inversely associated with cardiovascular risk, which appears to be independent of HDL concentration. The growing understanding of CEC and its role in cardiovascular risk decrease may improve the accuracy of cardiovascular risk prediction and also open important avenues to develop novel therapeutic targeting HDL metabolism.

Keywords: Cardiovascular risk; Cholesterol efflux capacity; High-density lipoprotein; Meta-analysis.

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The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram of study selection process
Fig. 2
Fig. 2
Pooled estimates of the relative risk of the incidence of cardiovascular events associated with CEC
Fig. 3
Fig. 3
Subgroup analyses of the relative risk of the incidence of cardiovascular events stratified by clinical characteristics of the participant and ethnicity. Notes: Phet was utilized to assess the between-study heterogeneity using the chi-squared-based Q test
Fig. 4
Fig. 4
Dose-response association between CEC and cardiovascular risk incidence
Fig. 5
Fig. 5
Pooled estimates of the odds ratios of the prevalence of cardiovascular events associated with CEC
Fig. 6
Fig. 6
Pooled estimates of the relative risk of all-cause mortality associated with CEC
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