Author + information
- Received September 12, 2018
- Revision received September 28, 2018
- Accepted September 30, 2018
- Published online December 17, 2018.
- Maryse Guerin, PhDa,∗,
- Johanne Silvain, MD, PhDa,b,∗,
- Julie Gall, PhDa,
- Maryam Darabi, PhDa,
- Myriam Berthet, PhDa,
- Eric Frisdal, PhDa,
- Marie Hauguel-Moreau, MDa,b,
- Michel Zeitouni, MDa,b,
- Mathieu Kerneis, MDa,b,
- Benoit Lattuca, MDa,b,
- Delphine Brugiera,b,
- Jean-Philippe Collet, MD, PhDa,b,
- Philippe Lesnik, PhDa and
- Gilles Montalescot, MD, PhDa,b,∗∗ (, )@ActionCoeur
- aINSERM UMRS1166, ICAN – Institute of CardioMetabolism and Nutrition, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
- bSorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN – Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
- ↵∗∗Address for correspondence:
Prof. Gilles Montalescot, ACTION Study Group, Bureau 1, 2ème étage, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
Background Serum cholesterol efflux capacity, a biomarker that integrates contributors and modulators of the initial step of the reverse cholesterol transport, has been associated with atherosclerosis independently of high-density lipoprotein (HDL) cholesterol level.
Objectives The authors evaluated the prognostic impact of serum cholesterol efflux capacity on mortality in a large cohort of patients hospitalized for an acute myocardial infarction (MI).
Methods Serum cholesterol efflux capacity, cholesteryl ester transfer protein (CETP) activity, total cholesterol, low-density lipoprotein cholesterol, HDL cholesterol, and triglyceride levels were measured in 1,609 consecutive patients admitted with an acute MI. The primary endpoint was all-cause mortality evaluated at 6 years with a median follow-up of 1.9 years (interquartile range: 1.5 to 4.2 years). An analysis by quartile of serum cholesterol efflux capacity was also performed.
Results In a fully adjusted model that included age, sex, traditional cardiovascular risk factors including lipid levels, and prognostic factors of MI, serum cholesterol efflux capacity was a strong predictor of survival (adjusted hazard ratio for mortality per 1-SD increase in serum cholesterol efflux capacity, 0.79; 95% confidence interval: 0.66 to 0.95; p = 0.0132). Patients displaying an elevated serum cholesterol efflux capacity had a marked lower rate of mortality at 6 years (adjusted hazard ratio: 0.54 [0.32 to 0.89]; p = 0.0165) as compared with patients with reduced serum cholesterol efflux capacity.
Conclusions Serum cholesterol efflux capacity, an integrative marker of reverse cholesterol transport pathway and efficacy, was inversely associated with all-cause mortality in MI patients independently of HDL cholesterol level and other risk factors.
↵∗ Drs. Guerin and Silvain contributed equally to this work.
This work was supported by Institut National de la Santé et de la Recherche Medicale (INSERM), the Institute of Cardiology and Metabolism (ICAN), the ACTION Coeur study group, and by the French National Agency through the national program Investissements d’Avenir Grant ANR-10-IAHU-05. Dr. Gall was a recipient of a research fellowship from the French Ministry of Research and Technology and from the New French Atherosclerosis Society (NSFA). Dr. Silvain has received research grants, honoraria, and/or travel support from Amgen, Algorythm, AstraZeneca, Bayer, Daiichi-Sankyo, Gilead Science, Sanofi, and WebMD. Dr. Zeitouni has received research grants from Servier and Fédération Française de Cardiologie. Dr. Kerneis has received research grants from Institut Servier, Fédération Française de Cardiologie, and Sanofi; and consulting fees from Bayer. Dr. Lattuca has received research grants from Biotronik, Daiichi-Sankyo, and Fédération Française de Cardiologie; consultant fees from Daiichi-Sankyo and Eli Lilly; and lecture fees from AstraZeneca, Daiichi-Sankyo, and Novartis. Dr. Collet has received research grants or honoraria from AstraZeneca, Bayer, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Fédération Française de Cardiologie, Lead-Up, Medtronic, Merck Sharp & Dohme, Sanofi, Servier, and WebMD. Prof. Montalescot has received research grants or honoraria from ADIR, Amgen, AstraZeneca, Bayer, Berlin Chimie AG, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women’s Hospital, Cardiovascular Research Foundation, Celladon, CME Resources, Daiichi-Sankyo, Eli Lilly, Europa, Elsevier, Fédération Française de Cardiologie, Fondazione Anna Maria Sechi per il Cuore, Gilead, ICAN, Janssen, Lead-Up, Menarini, Medtronic, Merck Sharp & Dohme, Pfizer, Sanofi, Servier, The Medicines Company, TIMI Study Group, and WebMD. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received September 12, 2018.
- Revision received September 28, 2018.
- Accepted September 30, 2018.
- 2018 American College of Cardiology Foundation
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