Objective
To investigate the association between serum cholesterol efflux capacity and all-cause and cardiovascular mortality in patients with coronary artery disease.
Design
Prospective cohort study.
Setting
Guangdong Coronary Artery Disease Cohort, established in 2008-2011.
Participants
1 765 patients with coronary artery disease were followed-up for a median of 3.9 years.
Main outcome measures
Primary outcome was the association of baseline serum cholesterol efflux capacity with the risks of all-cause and cardiovascular mortality.
Results:
During 6 778 person-years of follow-up, 170 deaths were registered, 126 of which were caused by cardiovascular diseases. After multivariate adjustment for factors related to cardiovascular diseases, the hazard ratios (95% confidence intervals) across quartiles of serum cholesterol efflux capacity were 1.00, 0.75 (0.51-1.10), 0.51 (0.33-0.81) and 0.43 (0.25-0.73) for all-cause mortality (
P
= 0.003), and 1.00, 0.76 (0.49-1.18), 0.37 (0.21-0.65), and 0.25 (0.12-0.52) for cardiovascular mortality (
P
< 0.001). Adding serum cholesterol efflux capacity to a model containing traditional cardiovascular risk factors significantly increases its discriminatory power and predictive ability for all-cause (area under receiver operating characteristic curve 0.68 versus 0.61,
P
< 0.001; net reclassification improvement 14.5%,
P
= 0.001) and cardiovascular (area under receiver operating characteristic curve 0.71 versus 0.63,
P
< 0.001; net reclassification improvement 18.4%,
P
< 0.001) death, respectively.
Conclusions:
Serum cholesterol efflux capacity may serve as an independent measure for predicting all-cause and cardiovascular mortality in patients with coronary artery disease.
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