High Density Lipoprotein Cholesterol Efflux Capacity and Atherosclerosis in Cardiovascular Disease: Pathophysiological Aspects and Pharmacological Perspectives.

Abstract: Background: A wealth of experimental and epidemiological evidence suggest that Apolipoprotein A-I (ApoA-I), the main protein constituent of high-density lipoprotein (HDL), may protect against Alzheimer disease (AD). To investigate this potential role, we conducted a meta-analysis of the published studies on the relationship between serum ApoA-I and AD occurrence. Methods: We screened MEDLINE, EMBASE, Web of Science, and Scopus, for cross-sectional studies published from inception to 1 March 2021, comparing the ApoA-I serum levels between patients with AD and cognitively normal controls. Results: From an initial screening of 245 articles, 5 studies, including 397 AD patients (mean age 75.0 years, 234 females) and 367 controls (mean age 69.2 years, 182 females), met the inclusion criteria. Compared to healthy controls, AD subjects had a lower ApoA-I serum level. The pooled weighted mean difference from a random-effects model was −0.31 g/L (p < 0.0001) (95% Confidence Interval: [−0.62–0.01], with high heterogeneity (I2 = 100%). The Egger’s test confirmed an absence of publication bias (t = 0.62, p = 0.576). Conclusions: Our study showed that AD patients present lower serum levels of ApoA-I compared to cognitively normal individuals. Further studies on large population samples are required to support this finding.

Abstract: The prevalence of NAFLD (non-alcoholic fatty liver disease) is a rapidly increasing problem, affecting a huge population around the globe. However, CVDs (cardiovascular diseases) are the most common cause of mortality in NAFLD patients. Atherogenic dyslipidemia, characterized by plasma hypertriglyceridemia, increased small dense LDL (low-density lipoprotein) particles, and decreased HDL-C (high-density lipoprotein cholesterol) levels, is often observed in NAFLD patients. In this review, we summarize recent genetic evidence, proving the diverse nature of metabolic pathways involved in NAFLD pathogenesis. Analysis of available genetic data suggests that the altered operation of fatty-acid β-oxidation in liver mitochondria is the key process, connecting NAFLD-mediated dyslipidemia and elevated CVD risk. In addition, we discuss several NAFLD-associated genes with documented anti-atherosclerotic or cardioprotective effects, and current pharmaceutical strategies focused on both NAFLD treatment and reduction of CVD risk.

Abstract: Background and aims Cholesterol efflux capacity is a functional property of high-density lipoproteins (HDL) reflecting the efficiency of the atheroprotective reverse cholesterol transport process in humans. Its relationship with calcific aortic valve stenosis (CAVS) has not been fully assessed yet. Methods We evaluated HDL-CEC in a patient population with varying degrees of aortic valvular calcific disease, assessed using echocardiography and cardiac computed tomography. Measurement of biomarkers that reflect osteogenic and tissue remodeling, along with dietary and gut microbiota-derived metabolites were performed. Results Patients with moderate-severe CAVS had significantly lower HDL-CEC compared to both control and aortic sclerosis subjects (mean: 6.09%, 7.32% and 7.26%, respectively). HDL-CEC displayed negative correlations with peak aortic jet velocity and aortic valve calcium score, indexes of CAVS severity (ρ = -0.298, p = 0.002 and ρ = -0.358, p = 0.005, respectively). In multivariable regression model, HDL-CEC had independent association with aortic valve calcium score (B: -0.053, SE: 0.014, p Conclusion These results indicate an impairment of HDL-CEC in moderate-severe CAVS and may contribute to identify potential novel targets for CAVS management.

Abstract: Objective: Our recent studies showed that desmocollin 1 (DSC1) binds to apoA-I in order to inhibit apoA-I-mediated high density lipoprotein (HDL) biogenesis in atherosclerotic plaques. To promote HDL biogenesis in the plaque, here we search for small molecules that block apoA-I-DSC1 interactions. Approach and Results: We combined mutational and computational mapping methods to show that amino acid residues 442-539 in the mature DSC1 protein form an apoA-I binding site (AIBS). Using a crystal structure of the AIBS, we carried out virtual screening of 10 million small molecules to estimate their binding affinities to the AIBS, followed by the selection of 51 high-affinity binding molecules as potential inhibitors of apoA-I-DSC1 interactions. Among the 51, the chemotherapy drug docetaxel showed the highest potency in promoting apoA-I-mediated HDL biogenesis in primary human skin fibroblasts with the half-maximal effective concentration of 0.72 nM. In silico docking studies suggest that the taxane ring in docetaxel binds to the AIBS and that the carbon-13 sidechain of the taxane tightens/stabilizes the binding. The HDL biogenic effect of docetaxel was also observed in two predominant cell types in atherosclerosis, macrophages and smooth muscle cells. Importantly, docetaxel promoted HDL biogenesis at concentrations much lower than those required for inducing cytotoxicity. Conclusions: Determination of the AIBS in DSC1 and AIBS structure-based virtual screening allowed us to identify docetaxel as a strong HDL biogenic agent. With the remarkable potency in promoting HDL biogenesis, a chemotherapy drug docetaxel may be repurposed to enhance atheroprotective HDL functions.

Abstract: Purpose of review High density lipoproteins (HDL) are a heterogeneous family of particles that contain distinct complements of proteins that define their function. Thus, it is important to accurately and sensitively identify proteins associated with HDL. Here we highlight the HDL Proteome Watch Database which tracks proteomics studies from different laboratories across the world. Recent findings In 45 published reports, almost 1000 individual proteins have been detected in preparations of HDL. Of these, 251 have been identified in at least three different laboratories. The known functions of these consensus HDL proteins go well beyond traditionally recognized roles in lipid transport with many proteins pointing to HDL functions in innate immunity, inflammation, cell adhesion, hemostasis and protease regulation, and even vitamin and metal binding. Summary The HDL proteome derived across multiple studies using various methodologies provides confidence in protein identifications that can offer interesting new insights into HDL function. We also point out significant issues that will require additional study going forward.

Abstract: The British Regional Heart Study (BRHS) reported in 1986 that much of the inverse relation of high-density lipoprotein cholesterol (HDLC) and incidence of coronary heart disease was eliminated by covariance adjustment. Using the proportional hazards model and adjusting for age, blood pressure, smoking, body mass index, and low-density lipoprotein cholesterol, we analyzed this relation separately in the Framingham Heart Study (FHS), Lipid Research Clinics Prevalence Mortality Follow-up Study (LRCF) and Coronary Primary Prevention Trial (CPPT), and Multiple Risk Factor Intervention Trial (MRFIT). In CPPT and MRFIT (both randomized trials in middle-age high-risk men), only the control groups were analyzed. A 1-mg/dl (0.026 mM) increment in HDLC was associated with a significant coronary heart disease risk decrement of 2% in men (FHS, CPPT, and MRFIT) and 3% in women (FHS). In LRCF, where only fatal outcomes were documented, a 1-mg/dl increment in HDLC was associated with significant 3.7% (men) and 4.7% (women) decrements in cardiovascular disease mortality rates. The 95% confidence intervals for these decrements in coronary heart and cardiovascular disease risk in the four studies overlapped considerably, and all contained the range 1.9-2.9%. HDLC levels were essentially unrelated to non-cardiovascular disease mortality. When differences in analytic methodology were eliminated, a consistent inverse relation of HDLC levels and coronary heart disease event rates was apparent in BRHS as well as in the four American studies.

Abstract: Background Inhibition of cholesteryl ester transfer protein (CETP) has been shown to have a substantial effect on plasma lipoprotein levels. We investigated whether torcetrapib, a potent CETP inhibitor, might reduce major cardiovascular events. The trial was terminated prematurely because of an increased risk of death and cardiac events in patients receiving torcetrapib. Methods We conducted a randomized, double-blind study involving 15,067 patients at high cardiovascular risk. The patients received either torcetrapib plus atorvastatin or atorvastatin alone. The primary outcome was the time to the first major cardiovascular event, which was defined as death from coronary heart disease, nonfatal myocardial infarction, stroke, or hospitalization for unstable angina. Results At 12 months in patients who received torcetrapib, there was an increase of 72.1% in high-density lipoprotein cholesterol and a decrease of 24.9% in low-density lipoprotein cholesterol, as compared with baseline (P<0.001 for both compari...

Abstract: In this retrospective cohort study, we determined the long-term mortality (from 1984 to 2002) among 9949 patients who had undergone gastric bypass surgery and 9628 severely obese persons who applied for driver’s licenses. From these subjects, 7925 surgical patients and 7925 severely obese control subjects were matched for age, sex, and body-mass index. We determined the rates of death from any cause and from specific causes with the use of the National Death Index. Results During a mean follow-up of 7.1 years, adjusted long-term mortality from any cause in the surgery group decreased by 40%, as compared with that in the control group (37.6 vs. 57.1 deaths per 10,000 person-years, P<0.001); cause-specific mortality in the surgery group decreased by 56% for coronary artery disease (2.6 vs. 5.9 per 10,000 person-years, P = 0.006), by 92% for diabetes (0.4 vs. 3.4 per 10,000 person-years, P = 0.005), and by 60% for cancer (5.5 vs. 13.3 per 10,000 person-years, P<0.001). However, rates of death not caused by disease, such as accidents and suicide, were 58% higher in the surgery group than in the control group (11.1 vs. 6.4 per 10,000 person-years, P = 0.04). Conclusions Long-term total mortality after gastric bypass surgery was significantly reduced, particularly deaths from diabetes, heart disease, and cancer. However, the rate of death from causes other than disease was higher in the surgery group than in the control group.

Abstract: Authors/Task Force Members (François Macha,∗,2, Colin Baigentb,∗∗,2, Alberico L. Catapanoc,∗∗∗,1,2, Konstantinos C. Koskinad, Manuela Casulae,f,1, Lina Badimong, M. John Chapmanh,i,cm,1, Guy G. De Backerj, Victoria Delgadok, Brian A. Ferencel, Ian M. Grahamm, Alison Hallidayn, Ulf Landmessero,p,q, Borislava Mihaylovar,s, Terje R. Pedersent, Gabriele Riccardiu,1, Dimitrios J. Richterv, Marc S. Sabatinew, Marja-Riitta Taskinenx,1, Lale Tokgozogluy,1, Olov Wiklundz), ESC Committee for Practice Guidelines (CPG) (Stephan Windeckeraa, Victor Aboyansab, Colin Baigentac, Jean-Philippe Colletab, Veronica Deanab, Victoria Delgadoad, Donna Fitzsimonsac, Chris P. Galeac, Diederick Grobbeead, Sigrun Halvorsenae, Gerhard Hindricksaf, Bernard Iungab, Peter Jüniag, Hugo A. Katusaf, Ulf Landmesseraf, Christophe Leclercqab, Maddalena Lettinoah, Basil S. Lewisai, Bela Merkelyaj, Christian Muelleraa, Steffen Petersenac, Anna Sonia Petronioah, Dimitrios J. Richterak, Marco Roffiaa, Evgeny Shlyakhtoal, Iain A. Simpsonac, Miguel Sousa-Uvaam, Rhian M. Touyzac), ESC National Cardiac Societies (Djamaleddine Nibouchean, Parounak H. Zelveianao, Peter Siostrzonekap, Ruslan Najafovaq, Philippe van de Bornear, Belma Pojskicas, Arman Postadzhiyanat, Lambros Kyprisau, Jindřich Špinarav, Mogens Lytken Larsenaw, Hesham Salah Eldinax, Margus Viigimaaay, Timo E. Strandbergaz, Jean Ferrièresba, Rusudan Agladzebb, Ulrich Laufsbc, Loukianos Rallidisbd, László Bajnokbe, Thorbjörn Gudjónssonbf, Vincent Maherbg, Yaakov Henkinbh, Michele Massimo Guliziabi, Aisulu Mussagaliyevabj, Gani Bajraktaribk, Alina Kerimkulovabl, Gustavs Latkovskisbm, Omar Hamouibn, Rimvydas Slapikasbo, Laurent Visserbp, Philip Dinglibq, Victoria Ivanovbr, Aneta Boskovicbs, Mbarek Nazzibt, Frank Visserenbu, Irena Mitevskabv, Kjetil Retterstølbw, Piotr Jankowskibx, Ricardo Fontes-Carvalhoby, Dan Gaitabz, Marat Ezhovca, Marina Foscolicb, Vojislav Gigacc, Daniel Pellacd, Zlatko Frasce, Leopoldo Perez de Islacf, Emil Hagströmcg, Roger Lehmannch, Leila Abidci, Oner Ozdogancj, Olena Mitchenkock, Riyaz S. Patelcl)