Serum Cholesterol Efflux Capacity Inversely Associated With Mortality After MI

LDL receptors
LDL receptors
An integrative marker of the reverse cholesterol transport pathway was inversely associated with all-cause mortality in MI.

Serum cholesterol efflux capacity is inversely associated with all-cause mortality after myocardial infarction (MI), according to a study recently published in The Journal of the American College of Cardiology. This association was found to be independent of other factors including high-density lipoprotein cholesterol levels.

This study included 1609 participants hospitalized for severe MI. Measures included triglycerides, total cholesterol, low-density and high-density lipoprotein cholesterol, activity in cholesteryl ester transfer protein (CETP), and serum cholesterol efflux capacity.

All-cause mortality was the study’s primary end point and was assessed at year 6 with a 1.9-year median follow-up. The effect of serum cholesterol efflux capacity from human macrophage cell line on all-cause mortality was analyzed by quartile. A chi-square test was used to compare qualitative variables and an unpaired Student’s t-test was used to compare the 2 groups of participants.

Of the study sample, 14.8% (n=239) participants died. Serum cholesterol efflux capacity was higher among survivors (0.818±0.138) than among those who died (0.762±0.140; <.0001), and was a significant predictor of survival, with each additional 1-standard-deviation increase resulting in an adjusted mortality hazard ratio of 0.79 (95% CI, 0.66-0.95; =.013).

High-density lipoprotein and CETP did not correlate with survival rates. At year 6, mortality was lower among those with higher serum cholesterol efflux capacity vs lower (adjusted hazard ratio: 0.54; 95% CI, 0.32-0.89; =.0165).

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Limitations to this study included a small cohort, a lack of data on secondary cardiovascular events, and no measurements of apolipoprotein A-I for comparison with serum cholesterol efflux capacity.

The study researchers conclude that the “findings indicate that serum cholesterol efflux capacity is a useful biomarker to identify patients at higher risk of mortality after an acute coronary event. It also validates the hypothesis of an ongoing trial aiming to restore cholesterol efflux capacity with an innovative therapy in post-MI patients.”

Some authors report financial contributions from pharmaceutical companies. For a full list of author disclosures, see the reference.


Guerin M, Silvain J, Gall J, et al. Association of serum cholesterol efflux capacity with mortality in patients with ST-segment elevation myocardial infarctionJ Am Coll Cardiol. 2018;72:3259-3269.