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CLINICAL STUDIES

Quantity and function of high density lipoprotein as an indicator of coronary atherosclerosis

^a Department of Internal Medicine and Pathology, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan
^* Department of Pediatrics, Ryukyus University School of Medicine, Okinawa 904-2300, Japan

Manuscript received April 15, 1998; revised manuscript received August 25, 1998, accepted October 2, 1998.

Reprint requests and correspondence: Keijiro Saku, Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1 Nanakuma Jonan-ku, Fukuoka 814-80, Japan
hh035399{at}msat.fukuoka-u.ac.jp

Objectives

To examine the association between the fractional esterification rate of cholesterol (C) in low density lipoprotein- and very low density lipoprotein-depleted plasma (FER_HDL) and coronary artery disease (CAD) and the influence of serum HDL-C levels.

Background

The function of HDL in reverse cholesterol transport is involved in the antiatherogenic action of HDL, and FER_HDL is a newly established quantitative measure of HDL function in vivo.

Methods

Cases (n = 185, F/M: 43/142) and controls (n = 74, F/M:27/47) were defined as subjects with/without angiographically proven CAD, respectively.

Results

The cases had significantly (p < 0.05) higher FER_HDL values (13.2 ± 0.3 %/h vs. 12.1 ± 0.5 %/h) and lower HDL-C levels (39.0 ± 1.0 mg/dL vs. 46.8 ± 1.4 mg/dL) than the controls. The associations of FER_HDL and HDL-C with CAD were linear and significant (p < 0.05). Multiple logistic regression analysis indicated that the association of FER_HDL with CAD varied with the HDL-C level: significant for the low HDL-C tertile (chi-square = 6.20, p < 0.05) but not significant for the middle and high HDL-C tertiles (chi-square = 0.08 and 0.03, n.s.). The risk of CAD, relative to that in patients with low FER_HDL and high HDL-C, was higher in patients with low FER_HDL and low HDL-C (odds ratio [95% confidence interval]: 2.37 [1.12–4.97], p < 0.05) and was highest in patients with high FER_HDL and low HDL-C (3.85 [1.84–8.06], p < 0.01).

Conclusions

The functional assay of HDL (FER_HDL) is an independent risk factor for CAD. The combination of FER_HDL and HDL-C could be a potent indicator for CAD, and may reflect a potential mechanism of atherosclerosis.

Abbreviations and Acronyms   Apo = apolipoprotein   CAD = coronary artery disease   CETP = cholesterol ester transfer protein   CAG = diagnostic coronary angiography   FC = free cholesterol   FERHDL = fractional esterification rate in the HDL fraction of plasma   HDL-C = high density lipoprotein cholesterol   LCAT = lecithin:cholesterol acyltransferase   LDL-C = low density lipoprotein cholesterol   RCT = reverse cholesterol transport   TC = total cholesterol

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