Roles of cholesterol efflux capacity in the occurrence and prognosis coronary artery disease

Abstract

Background The association between cholesterol efflux capacity (CEC) with the occurrence and prognosis of coronary artery disease (CAD) remains unrevealed. In our study, a systematic review was performed to quantitively analyze the association between CEC and the risk of CAD and follow-up endpoint events of the patients with CAD.Methods A systematic search of electronic databases (PubMed, EMBASE, OVID, Web of Science and Cochrane Library) for studies published until September 2019 was performed. Cohort, case-control studies, and randomized controlled trials that examined the effect of CEC on risk and prognosis of CAD were included.Results Eighteen studies involving a total of 12615 subjects that met the inclusion criteria were included. Among them, 14 studies reported the CEC levels in control and CAD group and 8 of them analyzed the association of CEC with risk of CAD. Four studies reported the prognosis of CAD or acute coronary syndrome (ACS). From the pooled analyses, significantly decreased CEC level was shown in patients with stable CAD in comparison with the control. It was also true in subgroup analysis of the patients with ACS. The decreased CEC was significantly associated with increased risk of CAD (OR=0.65, 95% CI: 0.55-0.75, P<0.001). Decreased CEC level predicted higher all-cause (OR= 0.39, 95% CI: 0.20-0.77, P=0.007) and cardiovascular related mortality (OR= 0.34, 95% CI: 0.13-0.90, P=0.03) risk in patients with CAD. However, CEC levels failed to predict the occurrence of stroke and myocardial infraction in patients with CAD.Conclusions Decreased cholesterol efflux capacity is an independent risk factor for the occurrence of CAD patients, and its level predicts all-cause and cardiovascular related mortality risk in patients with CAD. Prospective studies should further investigate whether CEC control might improve outcomes in CAD patients.