Chaoqun Liu1, Yuan Zhang2, Ding Ding1, Xinrui Li1, Yunou Yang1, Qing Li1, Yuanzhu Zheng1, Dongliang Wang3, Wenhua Ling4. 1. Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China. 2. Department of Cardiology, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangdong, China. 3. Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China. Electronic address: wdliang@mail.sysu.edu.cn. 4. Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China. Electronic address: lingwh@mail.sysu.edu.cn.
Abstract
BACKGROUND: Although diminished cholesterol efflux capacity is positively related with prevalent coronary artery disease, its prognostic value for incident cardiovascular events remains a topic of debate. This work aims to investigate the association between cholesterol efflux capacity and all-cause and cardiovascular mortality in patients with coronary artery disease. METHODS AND RESULTS: We measured cholesterol efflux capacity at baseline in 1737 patients with coronary artery disease from the Guangdong Coronary Artery Disease Cohort. During 6645 person-years of follow-up, 166 deaths were registered, 122 of which were caused by cardiovascular diseases. After multivariate adjustment for factors related to cardiovascular diseases, the hazard ratios of cholesterol efflux capacity in the fourth quartile compared with those in the bottom quartile were 0.24 (95% confidence intervals 0.13-0.44) for all-cause mortality (P < 0.001), and 0.17 (95% confidence intervals 0.08-0.39) for cardiovascular mortality (P < 0.001). Adding cholesterol efflux capacity to a model containing traditional cardiovascular risk factors significantly increases its discriminatory power and predictive ability for all-cause (area under receiver operating characteristic curve 0.79 versus 0.76, P = 0.001; net reclassification improvement 14.5%, P = 0.001; integrated discrimination improvement 0.016, P < 0.001) and cardiovascular (area under receiver operating characteristic curve 0.81 versus 0.78, P = 0.001; net reclassification improvement 18.4%, P < 0.001; integrated discrimination improvement 0.015, P < 0.001) death, respectively. CONCLUSIONS: Cholesterol efflux capacity may serve as an independent measure for predicting all-cause and cardiovascular mortality in patients with coronary artery disease.
BACKGROUND: Although diminished cholesterol efflux capacity is positively related with prevalent coronary artery disease, its prognostic value for incident cardiovascular events remains a topic of debate. This work aims to investigate the association between cholesterol efflux capacity and all-cause and cardiovascular mortality in patients with coronary artery disease. METHODS AND RESULTS: We measured cholesterol efflux capacity at baseline in 1737 patients with coronary artery disease from the Guangdong Coronary Artery Disease Cohort. During 6645 person-years of follow-up, 166 deaths were registered, 122 of which were caused by cardiovascular diseases. After multivariate adjustment for factors related to cardiovascular diseases, the hazard ratios of cholesterol efflux capacity in the fourth quartile compared with those in the bottom quartile were 0.24 (95% confidence intervals 0.13-0.44) for all-cause mortality (P < 0.001), and 0.17 (95% confidence intervals 0.08-0.39) for cardiovascular mortality (P < 0.001). Adding cholesterol efflux capacity to a model containing traditional cardiovascular risk factors significantly increases its discriminatory power and predictive ability for all-cause (area under receiver operating characteristic curve 0.79 versus 0.76, P = 0.001; net reclassification improvement 14.5%, P = 0.001; integrated discrimination improvement 0.016, P < 0.001) and cardiovascular (area under receiver operating characteristic curve 0.81 versus 0.78, P = 0.001; net reclassification improvement 18.4%, P < 0.001; integrated discrimination improvement 0.015, P < 0.001) death, respectively. CONCLUSIONS:Cholesterol efflux capacity may serve as an independent measure for predicting all-cause and cardiovascular mortality in patients with coronary artery disease.
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