BACKGROUND High-density lipoprotein (HDL) may provide cardiovascular protection by promoting reverse cholesterol transport from macrophages. We hypothesized that the capacity of HDL to accept cholesterol from macrophages would serve as a predictor of atherosclerotic burden. METHODS We measured cholesterol efflux capacity in 203 healthy volunteers who underwent assessment of carotid artery intima–media thickness, 442 patients with angiographically confirmed coronary artery disease, and 351 patients without such angiographically confirmed disease. We quantified efflux capacity by using a validated ex vivo system that involved incubation of macrophages with apolipoprotein B–depleted serum from the study participants. RESULTS The levels of HDL cholesterol and apolipoprotein A-I were significant determinants of cholesterol efflux capacity but accounted for less than 40% of the observed variation. An inverse relationship was noted between efflux capacity and carotid intima–media thickness both before and after adjustment for the HDL cholesterol level. Furthermore, efflux capacity was a strong inverse predictor of coronary disease status (adjusted odds ratio for coronary disease per 1-SD increase in efflux capacity, 0.70; 95% confidence interval [CI], 0.59 to 0.83; P<0.001). This relationship was attenuated, but remained significant, after additional adjustment for the HDL cholesterol level (odds ratio per 1-SD increase, 0.75; 95% CI, 0.63 to 0.90; P = 0.002) or apolipoprotein A-I level (odds ratio per 1-SD increase, 0.74; 95% CI, 0.61 to 0.89; P = 0.002). Additional studies showed enhanced efflux capacity in patients with the metabolic syndrome and low HDL cholesterol levels who were treated with pioglitazone, but not in patients with hypercholesterolemia who were treated with statins. CONCLUSIONS Cholesterol efflux capacity from macrophages, a metric of HDL function, has a strong inverse association with both carotid intima–media thickness and the likelihood of angiographic coronary artery disease, independently of the HDL cholesterol level. (Funded by the National Heart, Lung, and Blood Institute and others.)

HDL has less anti-inflammatory capacity as assessed by HII in the setting of ACS compared with controls or subjects with chronic CAD.

Objectives To examine the prevalence and incidence of cardiovascular risk factors (CVRFs) including hypertension (HTN), hyperlipidemia (HL), diabetes mellitus (DM), and obesity among patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA) compared to the general population, and to examine the treatment of incident CVRFs in PsA and RA compared to controls. Methods A cohort study was conducted within The Health Improvement Network, a medical record database in the United Kingdom, using data from 1994 to 2014. Patients age 18-89 with PsA or RA were matched to controls on practice and start date. The prevalence and incidence of CVRFs identified by diagnostic codes were calculated. Cox proportional hazards models were used to examine the relative incidence of these cardiovascular risk factors. Finally, pharmacologic therapies for incident CVRFs were examined. Results Study subjects included patients with PsA (N=12,548), RA (N=53,215), and controls (N=389,269). The prevalence of all CVRFs was significantly elevated in PsA. Only the prevalence of DM and obesity was increased in RA. Incidence of HTN, HL, and DM was elevated in PsA and RA. Receipt of therapy within one year following incident diagnosis of CVRFs was not substantially different between the groups; approximately 85%, 65%, and 45% of patients received prescriptions for HTN, HL, and DM, respectively. Conclusion Patients with PsA have an increased prevalence of CVRFs, and both patients with PsA and RA have increased incidence of new diagnosis of CVRFs. Pharmacologic treatment of CVRFs in patients with PsA and RA was similar to controls in the UK.

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