ArticleArteriosclerosis, thrombosis, and vascular biology2013
Paradoxical association of enhanced cholesterol efflux with increased incident cardiovascular risks.
Article in Arteriosclerosis, thrombosis, and vascular biology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 149 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
149 citing papers in PubMed, 4 syntheses or guidelines pooled it, 300 citations in OpenAlex.
- The association between cholesterol efflux capacity and apolipoprotein A1: systematic review and meta-analysis.Biochemia medica · 2025Pooled it
- High-density lipoprotein cholesterol efflux capacity and incidence of coronary artery disease and cardiovascular mortality: a systematic review and meta-analysis.Lipids in health and disease · 2022Pooled it
- Cholesterol Efflux Capacity and Its Association With Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis.Frontiers in cardiovascular medicine · 2021Pooled it
- High-density lipoprotein cholesterol efflux capacity is inversely associated with cardiovascular risk: a systematic review and meta-analysis.Lipids in health and disease · 2017Pooled it
- Cholesterol efflux capacity, HDL cholesterol, and risk of coronary heart disease: a nested case-control study in men.Journal of lipid research · 2019Trial
- Saturated Fats from Butter but Not from Cheese Increase HDL-Mediated Cholesterol Efflux Capacity from J774 Macrophages in Men and Women with Abdominal Obesity.The Journal of nutrition · 2018Trial
- Trial
- Effect of vitamin E supplementation on HDL function by haptoglobin genotype in type 1 diabetes: results from the HapE randomized crossover pilot trial.Acta diabetologica · 2016Trial
- A single infusion of MDCO-216 (ApoA-1 Milano/POPC) increases ABCA1-mediated cholesterol efflux and pre-beta 1 HDL in healthy volunteers and patients with stable coronary artery disease.European heart journal. Cardiovascular pharmacotherapy · 2016Trial
- Cholesterol efflux capacity in humans with psoriasis is inversely related to non-calcified burden of coronary atherosclerosis.European heart journal · 2015Trial
- No effect of acute exposure to coarse particulate matter air pollution in a rural location on high-density lipoprotein function.Inhalation toxicology · 2014Trial
- Perimenopausal transdermal estradiol replacement reduces serum HDL cholesterol efflux capacity but improves cardiovascular risk factors.Journal of clinical lipidologyTrial
- Postoperative Stress Accelerates Atherosclerosis Through Inflammatory Remodeling of the HDL Proteome and Impaired Reverse Cholesterol Transport.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- Noncatalytic Functions Are Required for MPO and PON1 in Modulating the Involvement of Monocytes and Endothelial Cells in Atherosclerosis.Biochemistry research international · 2026Article
- HDL metabolism and function in diabetes mellitus.Nature reviews. Endocrinology · 2026Review
- Radiolabeling lipoproteins to study and manage disease.European journal of nuclear medicine and molecular imaging · 2025Review
- Multiple facets of HDLs as modifiable risk factors in stroke-the good, the bad, and the ugly.Journal of lipid research · 2025Review
- Itaconate alleviates cholesterol burden via ABCA1 stabilization and cholesterol efflux.Atherosclerosis · 2025Article
- Reverse cholesterol transport: current assay methods, alterations with disease and response to therapeutic intervention.Frontiers in cardiovascular medicine · 2025Review
- Involvement of Expression of miR33-5p and ABCA1 in Human Peripheral Blood Mononuclear Cells in Coronary Artery Disease.International journal of molecular sciences · 2024Article
89 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
12 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveDiminished cholesterol efflux activity of apolipoprotein B (apoB)-depleted serum is associated with prevalent coronary artery disease, but its prognostic value for incident cardiovascular events is unclear. We investigated the relationship of cholesterol efflux activity with both prevalent coronary artery disease and incident development of major adverse cardiovascular events (death, myocardial infarction, or stroke). APPROACH AND
resultsCholesterol efflux activity from free cholesterol-enriched macrophages was measured in 2 case-control cohorts: (1) an angiographic cohort (n=1150) comprising stable subjects undergoing elective diagnostic coronary angiography and (2) an outpatient cohort (n=577). Analysis of media from cholesterol efflux assays revealed that the high-density lipoprotein fraction (1.063<d<1.21) contained only a minority (≈ 40%) of [(14)C]cholesterol released, with the majority found within the lipoprotein particle-depleted fraction, where ≈ 60% was recovered after apolipoprotein A1 immunoprecipitation. Albumin immunoprecipitation recovered another ≈ 30% of radiolabeled cholesterol within this fraction. Enhanced cholesterol efflux activity from ATP-binding cassette transporter A1-stimulated macrophages was associated with reduced risk of prevalent coronary artery disease in unadjusted models within both cohorts; however, the inverse risk relationship remained significant after adjustment for traditional coronary artery disease risk factors only within the outpatient cohort. Surprisingly, higher cholesterol efflux activity was associated with increase in prospective (3 years) risk of myocardial infarction/stroke (adjusted hazard ratio, 2.19; 95% confidence interval, 1.02-4.74) and major adverse cardiovascular events (adjusted hazard ratio, 1.85; 95% confidence interval, 1.11-3.06).
conclusionsHeightened cholesterol efflux to apoB-depleted serum was paradoxically associated with increased prospective risk for myocardial infarction, stroke, and death. The majority of released radiolabeled cholesterol from macrophages in cholesterol efflux activity assays does not reside within a high-density lipoprotein particle.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.