Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; PhD Program in Food Sciences and Nutrition, Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Science, Campus de l'Alimentació Torribera, University of Barcelona, Barcelona, Spain; Department of Behavioural Science and Health, University College London, London, United Kingdom.
Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain.
Atherosclerosis. 2020 Jun;302:36-42. doi: 10.1016/j.atherosclerosis.2020.04.015. Epub 2020 Apr 28.
The aim of this systematic review and meta-analysis is to synthesize studies assessing the associations between high-density lipoprotein functionality and risk of cardiovascular disease and mortality.
We searched Medline and Embase for the identification of observational studies meeting the inclusion criteria. This meta-analysis was conducted following the PRISMA statement and was registered in PROSPERO (CRD42017065857). We pooled risk estimates with a random-effect model separately for cardiovascular disease (fatal and non-fatal) and all-cause mortality.
Out of 29 manuscripts, 20 articles investigated cholesterol efflux capacity (13 prospective and 7 cross-sectional), 10 antioxidant capacity (7 prospective and 3 cross-sectional) and two anti-inflammatory capacity of high-density lipoprotein (1 prospective and 1 cross-sectional). A greater cholesterol efflux capacity was associated with lower risk of cardiovascular disease in 8 studies (RR for 1SD increase: 0.86; 95% CI: 0.76-0.98) and of mortality in 5 studies (RR for 1SD increase: 0,77; 0.60-1.00). Better antioxidant capacity was non-significantly associated with lower cardiovascular disease risk in 2 studies (RR for 1SD increase 0.70; 0.32-1.53) and significantly with mortality in 3 studies (RR for 1SD increase 0.48; 0.28-0.81). High-density lipoprotein anti-inflammatory ability was associated with a lower cardiovascular disease risk in the only prospective study.
Greater high-density lipoprotein cholesterol efflux capacity and antioxidant/anti-inflammatory capacities were associated with lower risk of cardiovascular disease. However, the heterogeneity between studies and evidence of publication bias warrants caution and highlights the need for larger prospective studies with standardized assays and specific outcomes.
本系统评价和荟萃分析旨在综合评估高密度脂蛋白功能与心血管疾病和死亡率风险之间关联的研究。
我们检索了 Medline 和 Embase，以确定符合纳入标准的观察性研究。本荟萃分析遵循 PRISMA 声明，并在 PROSPERO（CRD42017065857）中进行了注册。我们采用随机效应模型分别汇总心血管疾病（致死性和非致死性）和全因死亡率的风险估计值。
在 29 篇手稿中，有 20 篇文章研究了胆固醇外排能力（13 项前瞻性和 7 项横断面研究）、10 项抗氧化能力（7 项前瞻性和 3 项横断面研究）和 2 项高密度脂蛋白抗炎能力（1 项前瞻性和 1 项横断面研究）。8 项研究表明，胆固醇外排能力较高与心血管疾病风险降低相关（每增加 1SD 的 RR：0.86；95%CI：0.76-0.98），5 项研究表明，死亡率降低相关（每增加 1SD 的 RR：0.77；0.60-1.00）。2 项研究表明，更好的抗氧化能力与心血管疾病风险降低呈非显著相关（每增加 1SD 的 RR：0.70；0.32-1.53），3 项研究表明，与死亡率降低呈显著相关（每增加 1SD 的 RR：0.48；0.28-0.81）。唯一的前瞻性研究表明，高密度脂蛋白抗炎能力与心血管疾病风险降低相关。
更高的高密度脂蛋白胆固醇外排能力和抗氧化/抗炎能力与心血管疾病风险降低相关。然而，研究之间的异质性和发表偏倚的证据表明需要谨慎，并强调需要进行更大规模的前瞻性研究，使用标准化的检测方法和特定的结局。
