scholarly journals HDL cholesterol efflux capacity and concentration in patients with rheumatoid arthritis: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Binbin Xie ◽  
Jiang He ◽  
Yong Liu ◽  
Ting Liu ◽  
Chaoqun Liu

Abstract Background: Poor cholesterol efflux capacity (CEC) has been proposed to be an independent risk factor for cardiovascular diseases. However, the current evidences in the literature are inconsistent. This meta-analysis aimed to identify whether CEC is impaired or altered by drug therapy in individuals with rheumatoid arthritis (RA).Methods: The PubMed, Embase, and Cochrane library databases were searched to identify studies on CEC in RA patients. The searches were focused on studies in human subjects that were published before 10 June 2020, without language restrictions. The primary outcomes were CEC and the high-density lipoprotein cholesterol (HDL-C) and C-reactive protein levels (CRP) levels.Results: A total of 11 eligible articles, including 6 observational and 5 intervention studies, were retrieved. The pooled results showed that CEC is not significantly lower in RA patients than in healthy controls (SMD: -0.22, 95% CI: -0.65 to 0.20), whereas the plasma HDL-C level is not significantly (WMD: -3.98, 95% CI: -8.32 to 0.37, I² = 54%, P for heterogeneity = 0.050) but is significantly decreased in the RA patients with moderate body mass index (BMI) (WMD: -5.46, 95% CI: -9.40 to -1.52, I² = 37%, P for heterogeneity = 0.175). Furthermore, in the before-after studies, the CEC of RA patients (SMD: 0.20, 95% CI: 0.03 to 0.38) increased, but the plasma HDL-C level (WMD: 3.26, 95% CI: -0.17 to 6.69) remained at a similar level after anti-rheumatic treatment compared to the baseline. In addition, stratified analysis suggested that the Disease Activity Score for 28 joints could be a potential source of heterogeneity for CEC. The funnel plot was relatively symmetric and did not suggest the presence of publication bias.Conclusion:The current meta-analysis demonstrated that HDL-mediated CEC can be improved by the early control of inflammation and anti-rheumatic treatment in RA patients, which is independent of HDL-C levels. Future research is needed to determine whether therapeutic strategies to enhance CEC in RA patients have beneficial effects for preventing CVD.

2020 ◽  
Author(s):  
Binbin Xie ◽  
Jiang He ◽  
Yong Liu ◽  
Ting Liu ◽  
Chaoqun Liu

Abstract Background: Poor cholesterol efflux capacity (CEC) has been proposed to be an independent risk factor for cardiovascular diseases. However, the current evidences in the literature are inconsistent. This meta-analysis aimed to identify whether CEC is impaired or altered by drug therapy in individuals with rheumatoid arthritis (RA).Methods: The PubMed, Embase, and Cochrane library databases were searched to identify studies on CEC in RA patients. The searches were focused on studies in human subjects that were published before 10 Sep 2020, without language restrictions. The primary outcomes were CEC and the high-density lipoprotein cholesterol (HDL-C) and C-reactive protein levels (CRP).Results: A total of 11 eligible articles, including 6 observational and 5 intervention studies, were retrieved. The pooled results showed that CEC is not significantly lower in RA patients than in healthy controls (SMD: -0.34, 95% CI: -0.83 to 0.14), whereas the plasma HDL-C level is not significantly lower HDL-C levels (WMD: -3.91, 95% CI: -7.15 to -0.68). Furthermore, in the before-after studies, the CEC of RA patients (SMD: 0.20, 95% CI: 0.02 to 0.37) increased, but the plasma HDL-C level (WMD: 3.63, 95% CI: -0.13 to 7.39) remained at a similar level after anti-rheumatic treatment compared to the baseline. In addition, the funnel plot was relatively symmetric and did not suggest the presence of publication bias.Conclusion: The current meta-analysis demonstrated that HDL-mediated CEC can be improved by the early control of inflammation and anti-rheumatic treatment in RA patients, which is independent of HDL-C levels. Future research is needed to determine whether therapeutic strategies to enhance CEC in RA patients have beneficial effects for preventing CVD.


2020 ◽  
Author(s):  
Binbin Xie ◽  
Jiang He ◽  
Yong Liu ◽  
Ting Liu ◽  
Chaoqun Liu

Abstract Background: HDL cholesterol efflux capacity has been proposed as an independent risk factor of cardiovascular diseases. However, the presented data has been less than convincing in RA. This meta-analysis aimed to identify whether CEC was impaired in RA or altered by drug therapy.Methods: PubMed, Embase, and Cochrane library databases were searched to identify studies for CEC in RA patients. The primary outcomes were CEC, high-density lipoprotein cholesterol and C-reactive protein.Results: A total of 11 eligible articles including 6 observational and 5 intervention studies. Pooled results showed there was no significantly decrease in the CEC of RA patients comparing with the healthy controls (SMD: -0.22, 95% CI: -0.65 to 0.20), whereas the plasma HDL-C levels was decreased in RA patients (WMD: -5.21, 95% CI: -7.69 to -2.72). Furthermore, in the before-after studies, CEC of RA patients (SMD: 0.20, 95% CI: 0.03 to 0.38) was increased but the plasma HDL-C levels (WMD: 3.26, 95% CI: -0.17 to 6.69) was similar after anti-rheumatic treatment comparing to the baseline. In addition, stratified analysis suggested that DAS28 could be potential sources of heterogeneity for CEC. The funnel plot was relatively symmetric and was not suggestive of presence of publication bias.Conclusion The current meta-analysis demonstrated a slight, nonsignificant, decrease in the CEC among RA patients as compared with healthy individuals, but it can be improved substantially following anti-rheumatic treatment. More large population studies evaluating the predictive role of CEC on cardiovascular risk in RA are needed.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Binbin Xie ◽  
Jiang He ◽  
Yong Liu ◽  
Ting Liu ◽  
Chaoqun Liu

Abstract Background Poor cholesterol efflux capacity (CEC) has been proposed to be an independent risk factor for cardiovascular diseases. However, current evidence is inconsistent, especially in rheumatoid arthritis (RA) patients. This meta-analysis aims to identify whether CEC is impaired or altered by drug therapy in RA. Methods The PubMed/MEDLINE, Embase, Cochrane Library and ClinicalTrials.gov databases were browsed to identify studies on CEC in RA patients. The searches mainly focused on studies in human subjects that were published before November 14, 2020, without any language restrictions. The effect size was pooled by the standardized mean differences and mean differences (SMD & MD) as well as the corresponding 95% confidence intervals (CIs) in a random or fixed effect model. Heterogeneity across the studies was tested using Cochran’s Q test and I2 statistic. Newcastle-Ottawa Scale and the Downs and Black scale (D&B) were applied to evaluate the quality of included studies. The GRADE-system with its 4-grade evidence scale was used to assess the quality of evidence. Results A total of 11 eligible articles, including 6 observational and 5 interventional studies, were retrieved. The pooled results showed that in patients with RA, CEC was not significantly different than in healthy controls (SMD: -0.34, 95% CI: − 0.83 to 0.14), whereas the plasma HDL-C levels was significantly lower (MD: -3.91, 95% CI: − 7.15 to − 0.68). Furthermore, in the before-after studies, the CEC of RA patients (SMD: 0.20, 95% CI: 0.02 to 0.37) increased, but the plasma HDL-C levels (MD: 3.63, 95% CI: − 0.13 to 7.39) remained at a comparable quantity after anti-rheumatic treatment comparing with the baseline. In addition, the funnel plot of included studies displayed a lightly asymmetry, while Egger’s and Begg’s test did not suggest the existence of publication bias. The quality of evidence was rated according to GRADE as moderate to very low. Conclusion The current meta-analysis demonstrated that HDL-mediated CEC can be improved by the early control of inflammation and anti-rheumatic treatment in RA patients, which is independent of the plasma HDL-C levels. However, the results should be interpreted with caution because of low-quality and limited quantity of evidence. Future randomized controlled trials are needed to determine whether therapeutic strategies to enhance CEC in RA patients have beneficial effects for preventing CVD.


Cells ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 574
Author(s):  
Maria Pia Adorni ◽  
Nicoletta Ronda ◽  
Franco Bernini ◽  
Francesca Zimetti

Over the years, the relationship between high-density lipoprotein (HDL) and atherosclerosis, initially highlighted by the Framingham study, has been revealed to be extremely complex, due to the multiple HDL functions involved in atheroprotection. Among them, HDL cholesterol efflux capacity (CEC), the ability of HDL to promote cell cholesterol efflux from cells, has emerged as a better predictor of cardiovascular (CV) risk compared to merely plasma HDL-cholesterol (HDL-C) levels. HDL CEC is impaired in many genetic and pathological conditions associated to high CV risk such as dyslipidemia, chronic kidney disease, diabetes, inflammatory and autoimmune diseases, endocrine disorders, etc. The present review describes the current knowledge on HDL CEC modifications in these conditions, focusing on the most recent human studies and on genetic and pathophysiologic aspects. In addition, the most relevant strategies possibly modulating HDL CEC, including lifestyle modifications, as well as nutraceutical and pharmacological interventions, will be discussed. The objective of this review is to help understanding whether, from the current evidence, HDL CEC may be considered as a valid biomarker of CV risk and a potential pharmacological target for novel therapeutic approaches.


2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Ali Javaheri ◽  
Payman Zamani ◽  
Maria Molina ◽  
Amrith Rodrigues ◽  
Susan Chambers ◽  
...  

Background: Coronary allograft vasculopathy (CAV) is an important cause of mortality after cardiac transplantation. High density lipoprotein (HDL) cholesterol efflux capacity has been inversely associated with coronary artery disease and is impaired in cardiac transplant recipients. We performed a single center case-cohort study to test the hypothesis that reduced efflux capacity is a risk factor for mortality and a second, multi-center retrospective study to test if efflux capacity is associated with CAV progression. Methods: We designed a single center case-cohort study in which we identified cardiac transplant patients who died between 2009-2012 (cases, n=34) and controls as cardiac transplant patients who were alive as of the fourth quarter of 2013 (n=57). Efflux capacity was measured by incubating apolipoprotein B-depleted serum with macrophages in a validated ex vivo system. In a second study, we utilized pre-transplant samples from the Clinical Trials in Organ Transplantation 5 (CTOT5) study to determine the association between ATP-binding-cassette (ABC) A1-dependent cholesterol efflux and CAV progression at 1 year. Results: In our single center study, the average time from transplant to study entry was well-matched between cases and controls (7.6±1.0 vs 7.7±0.8 years, respectively, p=0.48). Multivariable Cox proportional hazard ratios demonstrated that higher levels of HDL cholesterol efflux capacity were associated with survival (HR 0.61, 95% CI 0.43-0.85), even after adjustment for HDL cholesterol mass. To determine whether excess mortality observed in subjects with reduced efflux could be attributable to CAV progression, we tested the relationship between intravascular ultrasound (IVUS) progression of CAV and cholesterol efflux capacity using linear regression. ABCA1-dependent efflux and IVUS progression were significantly associated (β = -0.90, 95% CI [-1.73 - -0.07], p = 0.037, R2 = 0.37). Conclusion: Reduced efflux capacity is an important mediator of CAV progression and mortality in cardiac transplant recipients. This finding suggests that interventions to increase HDL cholesterol efflux capacity may provide clinical benefit in cardiac transplant recipients.


2019 ◽  
Vol 39 (4) ◽  
Author(s):  
Yuna Horiuchi ◽  
Ryunosuke Ohkawa ◽  
Shao-Jui Lai ◽  
Shitsuko Shimano ◽  
Michio Hagihara ◽  
...  

Abstract Cholesterol efflux capacity (CEC) in atherosclerotic lesions is the main anti-atherosclerotic function of high-density lipoprotein (HDL). In recent studies, apolipoprotein (apo) B-depleted serum (BDS) obtained with the polyethylene glycol (PEG) precipitation method is used as a cholesterol acceptor (CA) substitution for HDL isolated by ultracentrifugation. However, the suitability of BDS as a CA is controversial. In the present study, CEC obtained from BDS (BDS-CEC) was evaluated based on a parameter, defined as whole-CEC, which was calculated by multiplying CEC obtained using fixed amounts of HDL by cholesterol concentration to HDL-cholesterol (HDL-C) levels in the serum. Significant correlation (r = 0.633) was observed between both CECs. To eliminate systematic errors from possible contamination with serum proteins and low-density lipoprotein (LDL) or very-LDL (VLDL) in BDS-CEC, the deviation of each CEC-BDS from the regression equation was compared with serum protein, LDL, and triglyceride (TG) levels. No correlation was observed between the deviation and the levels of each of these serum components, indicating that the deviations do not derive from systematic error. Further, to evaluate the effects of serum protein on the results, we measured BDS-CEC of reconstituted serum samples prepared using combinations of five levels of serum proteins with five levels of HDL-C. No significant change in BDS-CEC was observed in any combination. These results indicate that BDS-CEC reflects not only the function of HDL but also its concentration in serum.


2020 ◽  
Vol 27 (5) ◽  
pp. 348-356 ◽  
Author(s):  
Mojgan Morvaridzadeh ◽  
Mahdi Sepidarkish ◽  
Farnaz Farsi ◽  
Abolfazl Akbari ◽  
Roghayeh Mostafai ◽  
...  

Introduction: Nuts are one of the dietary components which appear to have beneficial effects on cardiovascular disease biomarkers. Studies demonstrate beneficial effects of cash­ews on serum lipids concentration, but results in the literature remain inconclusive. We conducted a review to examine the effects of cashew nut supplementation on serum lipid profile. Methods: Two reviewers independently searched PubMed, Web of Science, Cochrane Library, Scopus, and EMBASE electronic databases from inception until June 2019 without language limitation. Random- and fixed-effects models were used to calculate 95% confidence intervals (CI) for studies. Results: Six randomized clinical trials comprising 531 participants were included in this systematic review. Three studies were included in the meta-analysis model. There were no significant changes for total cholesterol (TC) (standardized mean difference [SMD]: –0.02, 95% CI: –0.32, 0.28), triglycerides (TG) (SMD: –0.01, 95% CI: –0.22, 0.20), high-density lipoprotein (HDL) cholesterol (SMD: 0.09, 95% CI: –0.16, 0.34), or low-density lipoprotein (LDL) cholesterol (SMD: –0.18, 95% CI: –0.75, 0.39). Conclusion: The results of this analysis demonstrate that treatment with cashew nut supplementation alone did not significantly change serum levels of LDL, HDL, TC, or TG.


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