Metabolic syndrome (MetS) is characterized by adiposity and atherogenic dyslipidemia consisting of elevated triglyceride and decreased high density lipoprotein cholesterol (HDL-C) levels however, cholesterol concentration alone does not reflect HDL functionality. Cholesterol efflux capacity (CEC) captures a key anti-atherosclerotic function of HDL; studies linking CEC to MetS have yielded inconsistent findings and lacked racial/ethnic diversity. The aim of this study was to evaluate the association between CEC and MetS in a large multi-ethnic population utilizing two different CEC assays interrogating overlapping but distinct reverse cholesterol transport pathways. A cross-sectional study was performed using the Dallas Heart Study cohort and cholesterol efflux was measured with radiolabeled and fluorescent cholesterol assays. The relationship between CEC and MetS was assessed using multivariable regression analyses. A total of 2241 participants were included (mean age was 50 years; 38% men and 53% Blacks). CEC was independently and inversely associated with MetS irrespective of efflux assay (CEC-radiolabeled, adjusted OR 0·71 [95% CI 0·65-0·80]. CEC-fluorescent, adjusted OR 0·85 [95% CI 0·77-0·94]). Both CEC measures were inversely associated with waist circumference and directly associated with HDL-C but not with other MetS components. There was an interaction by sex but not by race such that the inverse associations between CEC and MetS were somewhat attenuated in men (OR 0·86, 95%CI 0·74-1·01). In this large multi-ethnic cohort, impaired CEC is linked to MetS irrespective of efflux assay and race/ethnicity but less so among men. Future studies are needed to assess whether CEC mediates the atherosclerotic cardiovascular disease risk of MetS.

中文翻译：

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胆固醇流出能力及其与多种族人群中普遍的代谢综合征的关联（达拉斯心脏研究）。

代谢综合征 (MetS) 的特点是肥胖和致动脉粥样硬化血脂异常，包括甘油三酯升高和高密度脂蛋白胆固醇 (HDL-C) 水平降低，然而，胆固醇浓度本身并不能反映 HDL 功能。胆固醇流出能力 (CEC) 捕获了 HDL 的关键抗动脉粥样硬化功能；将 CEC 与 MetS 联系起来的研究得出了不一致的结果，并且缺乏种族/民族多样性。本研究的目的是评估 CEC 和 MetS 在大型多种族人群中的关联，利用两种不同的 CEC 测定来询问重叠但不同的反向胆固醇转运途径。使用达拉斯心脏研究队列进行横断面研究，并用放射性标记和荧光胆固醇测定法测量胆固醇流出。使用多变量回归分析评估 CEC 和 MetS 之间的关系。共纳入 2241 名参与者（平均年龄为 50 岁；38% 为男性，53% 为黑人）。CEC 与 MetS 独立且负相关，与流出试验无关（CEC 放射性标记，调整 OR 0·71 [95% CI 0·65-0·80]。CEC 荧光，调整后 OR 0·85 [95% CI 0· 77-0·94]）。两种 CEC 测量值都与腰围呈负相关，并与 HDL-C 直接相关，但与其他 MetS 成分无关。存在性别而非种族的相互作用，因此 CEC 和 MetS 之间的负相关在男性中有所减弱（OR 0·86，95%CI 0·74-1·01）。在这个大型多种族队列中，受损的 CEC 与 MetS 相关，与外排测定和种族/民族无关，但在男性中则较少。