Background

Cholesterol Efflux Capacity (CEC) is considered to be a key atheroprotective property of high-density lipoproteins (HDL). However, the role of HDL-CEC in atherosclerosis and cardiovascular (CV) risk is still controversial, and data in individuals with diabetes are limited.

Objective

In this study, we have investigated the relationship of CEC and other HDL characteristics with clinical and subclinical atherosclerosis in subjects with elevated cardiovascular diseases (CVD) risk and Type 2 Diabetes Mellitus (T2DM).

Methods

Using multiple linear regression analyses, we determined the relationship of HDL-CEC with carotid intima-media thickness (cIMT, Z-Score), an endothelial dysfunction (EnD) Score (Z-Score), prevalent CVD (n = 150 cases) and history of CV events (CVE, n = 85 cases) in an observational cohort (CODAM, n = 574, 59.6 ± 0.3 yr, 61.3% men, 24.4% T2DM). Stratified analyses were performed to determine if the associations differed between individuals with normal glucose metabolism (NGM) and those with disturbed glucose metabolism.

Results

HDL-CEC was not associated with either marker of atherosclerosis (cIMT, EnD Score) nor with CVD or CVE. In contrast, other HDL characteristics that is, HDL-Cholesterol (HDL-C, Z-Score), apolipoprotein A-I (apoA-I, Z-Score), HDL size (Z-Score) and HDL particle number (HDL-P, Z-Score) were inversely and significantly associated with the EnD Score (s −0.226 to −0.097, P < .05) and CVE (ORs 0.61 to 0.68, P < .05). In stratified analyses, HDL size and HDL-P were significantly associated with the EnD Score in individuals with NGM (P_interaction .039 and .005, respectively), but not in those with (pre)diabetes. HDL-C and apoA-I were inversely associated with prevalent CVD in individuals with (pre)diabetes (P_interaction = .074 and .034, respectively), but not in those with NGM.

Conclusion

HDL-CEC is not associated with clinical or subclinical atherosclerosis, neither in the whole population nor in individuals with (pre)diabetes, while other HDL characteristics show atheroprotective associations. The atheroprotective associations of HDL-size and HDL-P are lost in (pre)diabetes, while higher concentrations of HDL-C and apoA-I are associated with a lower prevalence of CVD in (pre)diabetes.

中文翻译：

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高密度脂蛋白胆固醇外流能力与动脉粥样硬化和心血管预后的发生率无关：CODAM研究。

背景

胆固醇外排量（CEC）被认为是高密度脂蛋白（HDL）的关键动脉粥样硬化防护特性。但是，HDL-CEC在动脉粥样硬化和心血管（CV）风险中的作用仍存在争议，并且糖尿病患者的数据有限。

客观的

在这项研究中，我们研究了心血管疾病（CVD）风险升高和2型糖尿病（T2DM）患者的CEC和其他HDL特征与临床和亚临床动脉粥样硬化的关系。

方法

使用多重线性回归分析，我们确定了HDL-CEC与颈动脉内膜中层厚度（cIMT，Z评分），内皮功能障碍（EnD）评分（Z评分），普遍的CVD（n = 150例）和观察性队列（CODAM，n = 574，59.6±0.3年，男性61.3％，22.4％T2DM）的CV事件史（CVE，n = 85例）。进行了分层分析，以确定具有正常葡萄糖代谢（NGM）的个体和具有异常葡萄糖代谢的个体之间的关联是否不同。

结果

HDL-CEC与动脉粥样硬化的标志物（cIMT，EnD评分）均无关，也不与CVD或CVE相关。相比之下，其他HDL特征包括HDL-胆固醇（HDL-C，Z-Score），载脂蛋白AI（apoA-I，Z-Score），HDL大小（Z-Score）和HDL颗粒数（HDL-P， Z分数与EnD得分（s -0.226至-0.097，P  <.05）和CVE（OR介于0.61至0.68，P  <.05）成反比且显着相关。在分层分析中，NGM患者的HDL大小和HDL-P与EnD评分显着相关（P_交互作用分别为.039和.005），而患有（前）糖尿病的患者则没有。HDL-C和apoA-I与（患有）糖尿病的个体中普遍的CVD呈负相关（P_相互作用 分别为.074和.034），但在拥有NGM的公司中则没有。

结论

HDL-CEC在整个人群或患有（糖尿病前期的）糖尿病患者中均与临床或亚临床动脉粥样硬化无关，而其他HDL特征也显示出与动脉粥样硬化的保护性关联。在（前）糖尿病患者中，HDL大小和HDL-P的抗动脉粥样硬化关联消失，而（前）糖尿病患者中较高的HDL-C和apoA-I浓度与较低的CVD患病率相关。