高密度脂蛋白胆固醇外排能力与心血管风险呈负相关：系统评价和荟萃分析。
High-density lipoprotein cholesterol efflux capacity is inversely associated with cardiovascular risk: a systematic review and meta-analysis.
机构信息
Xiangya school of Pharmaceutical Sciences, Central South University, Changsha, Hunan, 410013, China.
Center for Vascular Disease and Translational Medicine, The Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China.
出版信息
Lipids Health Dis. 2017 Nov 10;16(1):212. doi: 10.1186/s12944-017-0604-5.
BACKGROUND
A low plasma level of high-density lipoprotein (HDL) cholesterol (HDL-C) is associated with cardiovascular risk. A key cardioprotective property of HDL is cholesterol efflux capacity (CEC), the ability of HDL to accept cholesterol from macrophages. In this study, we aimed to identify the predictive value of CEC for cardiovascular risk.
METHODS
The relative risks (RRs) and 95% confidence intervals (CIs) were pooled to analyze the association between CEC and the incidence of cardiovascular events and all-cause mortality. The odds ratios (ORs) and 95% CIs were pooled to estimate the association of CEC and the prevalence of cardiovascular events.
RESULTS
A total of 15 studies were included. Results showed that the highest CEC was significantly associated with a reduced risk of cardiovascular events incidents compared to the lowest CEC (RR, 0.56; 95% CI, 0.37 to 0.85; I , 89%); the pooled RR of cardiovascular risk for per unit SD increase was 0.87 (95% CI, 0.73 to 1.04; I , 67%). Dose-response curve indicated that cardiovascular risk decreased by 39% (RR, 0.61; 95% CI, 0.51 to 0.74) for per unit CEC increase. Similarly, an inverse association was observed between CEC and the prevalence of cardiovascular events (highest vs. lowest, OR, 0.30; 95% CI, 0.17 to 0.5; I = 63%; per unit SD increase, OR, 0.94; 95% CI, 0.90 to 0.98; I = 71%). However, based on the current data, CEC was not significantly associated with all-cause mortality.
CONCLUSIONS
Findings from this meta-analysis suggest that HDL-mediated CEC is inversely associated with cardiovascular risk, which appears to be independent of HDL concentration. The growing understanding of CEC and its role in cardiovascular risk decrease may improve the accuracy of cardiovascular risk prediction and also open important avenues to develop novel therapeutic targeting HDL metabolism.
背景
血浆高密度脂蛋白（HDL）胆固醇（HDL-C）水平低与心血管风险相关。HDL 的一个关键心脏保护特性是胆固醇外排能力（CEC），即 HDL 从巨噬细胞中摄取胆固醇的能力。在这项研究中，我们旨在确定 CEC 对心血管风险的预测价值。
方法
采用相对危险度（RR）和 95%置信区间（CI）进行荟萃分析，以分析 CEC 与心血管事件发生和全因死亡率之间的关系。采用优势比（OR）和 95%CI 进行荟萃分析，以估计 CEC 与心血管事件发生率的关系。
结果
共纳入 15 项研究。结果表明，与最低 CEC 相比，最高 CEC 与心血管事件发生率降低显著相关（RR，0.56；95%CI，0.37 至 0.85；I ² = 89%）；每单位 SD 增加的心血管风险的汇总 RR 为 0.87（95%CI，0.73 至 1.04；I ² = 67%）。剂量反应曲线表明，CEC 每增加一个单位，心血管风险降低 39%（RR，0.61；95%CI，0.51 至 0.74）。同样，CEC 与心血管事件的发生率呈负相关（最高与最低，OR，0.30；95%CI，0.17 至 0.5；I ² = 63%；每单位 SD 增加，OR，0.94；95%CI，0.90 至 0.98；I ² = 71%）。然而，根据目前的数据，CEC 与全因死亡率无显著相关性。
结论
本荟萃分析结果表明，HDL 介导的 CEC 与心血管风险呈负相关，这似乎独立于 HDL 浓度。对 CEC 及其在降低心血管风险中的作用的认识不断加深，可能会提高心血管风险预测的准确性，也为开发针对 HDL 代谢的新型治疗方法开辟重要途径。
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