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Objectives

High-density lipoprotein (HDL) is a pluripotent atheroprotective factor with reverse cholesterol transport, anti-inflammatory, and pro-angiogenic activities. Increasing evidence suggests that HDL function rather than concentration would be a more relevant measure to predict cardiovascular risk. In this study, we sought to investigate whether cholesterol efflux capacity (CEC) of HDL is related to coronary collateralization in patients with stable angina and chronic total occlusion.

Methods

CEC was determined in vitro in 115 patients with stable angina and angiographic total occlusion of at least one major coronary artery. The degree of coronary collaterals supplying the distal aspect of a total occlusion from the contralateral vessel was graded according to Rentrop classification.

Results

CEC of HDL was significantly elevated in good collateralization (Rentrop score of 2-3) than poor collateralization (Rentrop score of 0-1) group (15.39±10.17% vs. 10.18±5.41%, p=0.004). While CEC was positively correlated to Rentrop score (Spearman’s r=0.275, p=0.005), no correlation was observed between Rentrop score and serum levels of HDL-cholesterol or apolipoprotein A. Receiver operating characteristic curve yielded an AUC of 0.662 (95% confidence interval: 0.558-0.767, p=0.006) in discriminating good or poor collateralization. After adjusting for age, gender, body mass index and conventional risk factors for coronary artery disease in multivariate logistic regression analysis, CEC persisted to be an independent determinant for good collateralization (odds ratio: 1.11 per 1% increase, p=0.006).

Conclusions

Increased CEC of HDL is associated with good coronary collateralization in patients with stable angina and chronic total occlusion.