Dysfunctional High-Density Lipoproteins Are Associated With a Greater Incidence of Acute Coronary Syndrome in a Population at High Cardiovascular Risk: A Nested Case-Control Study.
Abstract | BACKGROUND: METHODS: We conducted a case-control study nested within the PREDIMED (Prevención con Dieta Mediterránea) cohort, originally a randomized trial in which participants followed a Mediterranean or low-fat diet. Incident acute coronary syndrome cases (N=167) were individually matched (1:2) to control patients by sex, age, intervention group, body mass index, and follow-up time. We investigated 2 individual manifestations ( myocardial infarction, unstable angina) as secondary outcomes. We measured the following functional characteristics: HDL cholesterol concentration (in plasma); cholesterol efflux capacity; antioxidant ability, measured by the HDL oxidative-inflammatory index; phospholipase A2 activity; and sphingosine-1-phosphate, apolipoproteins A-I and A-IV, serum amyloid A, and complement 3 protein (in apolipoprotein B-depleted plasma). We used conditional logistic regression models adjusted for HDL cholesterol levels and cardiovascular risk factors to estimate odds ratios ( ORs) between 1-SD increments in HDL functional characteristics and clinical outcomes. RESULTS: Low values of cholesterol efflux capacity (OR1SD, 0.58; 95% CI, 0.40-0.83) and low levels of sphingosine-1-phosphate (OR1SD, 0.70; 95% CI, 0.52-0.92) and apolipoprotein A-I (OR1SD, 0.58; 95% CI, 0.42-0.79) were associated with higher odds of acute coronary syndrome. Higher HDL oxidative inflammatory index values were marginally linked to acute coronary syndrome risk (OR1SD, 1.27; 95% CI, 0.99-1.63). Low values of cholesterol efflux capacity (OR1SD, 0.33; 95% CI, 0.18-0.61), sphingosine-1-phosphate (OR1SD: 0.60; 95% CI: 0.40-0.89), and apolipoprotein A-I (OR1SD, 0.59; 95% CI, 0.37-0.93) were particularly linked to myocardial infarction, whereas high HDL oxidative-inflammatory index values (OR1SD, 1.53; 95% CI, 1.01-2.33) and low apolipoprotein A-I levels (OR1SD, 0.52; 95% CI, 0.31-0.88) were associated with unstable angina. CONCLUSIONS: CLINICAL TRIAL REGISTRATION: URL: https://www.controlled-trials.com/ISRCTN35739639. Unique identifier: ISRCTN35739639.
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Authors | María Trinidad Soria-Florido, Olga Castañer, Camille Lassale, Ramon Estruch, Jordi Salas-Salvadó, Miguel Ángel Martínez-González, Dolores Corella, Emilio Ros, Fernando Arós, Roberto Elosua, José Lapetra, Miquel Fiol, Angel Alonso-Gómez, Enrique Gómez-Gracia, Lluís Serra-Majem, Xavier Pintó, Mònica Bulló, Miguel Ruiz-Canela, Jose V Sorlí, Álvaro Hernáez, Montserrat Fitó |
Journal | Circulation
(Circulation)
Vol. 141
Issue 6
Pg. 444-453
(02 11 2020)
ISSN: 1524-4539 [Electronic] United States |
PMID | 31941372
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Apolipoprotein A-I
- Lipoproteins, HDL
- Lysophospholipids
- sphingosine 1-phosphate
- Sphingosine
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Topics |
- Acute Coronary Syndrome
(blood, diet therapy)
- Aged
- Apolipoprotein A-I
(blood)
- Case-Control Studies
- Diet, Mediterranean
- Female
- Follow-Up Studies
- Humans
- Lipoproteins, HDL
(blood)
- Lysophospholipids
(blood)
- Male
- Middle Aged
- Sphingosine
(analogs & derivatives, blood)
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