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Association of extremely high levels of high-density lipoprotein cholesterol with endothelial dysfunction in men

髙永甲 有司 広島大学

2021.03.23

概要

Several lines of evidence have shown an inverse
relationship between high-density lipoprotein cholesterol
(HDL-C) levels and cardiovascular disease.1–3 It is well
known that HDL has an atheroprotective effect through
transportation of excess cholesterol from macrophages in
the liver and bile, namely, cholesterol reverse transport.4
In addition, HDL activates endothelial nitric oxide synthase
(eNOS), has antioxidant and anti-inflammatory effects and
an antithrombotic effect, and prevents apoptosis of endothelial cells induced by tumor necrosis factor alpha.5–8
However, cohort studies have shown that an extremely
high HDL-C group had high mortality and morbidity rates of
cardiovascular disease and that there was a U-shaped curve
between HDL-C levels and mortality and morbidity rates of
cardiovascular disease.9–11 In addition, recent large clinical
trials have shown that an increase in HDL-C levels with pharmacologic interventions does not reduce the risk of cardiovascular events. Cholesteryl ester transfer protein (CETP)
modulates the transfer of cholesteryl esters from HDL to
apolipoprotein B–containing lipoproteins.12 Pharmacologic
inhibition of CETP raises HDL-C levels and decreases lowdensity lipoprotein cholesterol (LDL-C) levels.13–16 Randomized clinical trials using CETP inhibitors such as torcetrapib, dalcetrapib, and evacetrapib have shown an increase
in mortality or a lack of efficacy, whereas CETP inhibitors
increased HDL-C levels.13–15 On the other hand, the CETP
inhibitor anacetrapib reduced the risk of major coronary
events during a 4-year treatment period.16 The mechanism
of this reduction seems to be largely explained by lowering
of non–HDL-C rather than increase in HDL-C.16 Results of
recent human genetic studies have shown that genetic conditions leading to increased HDL-C levels may not always be
associated with lower risk of atherosclerosis.17 Moreover, a
loss-of-function coding variant in SCARB1 leads to increased
risk of coronary heart disease despite elevation in HDL-C
levels.18 These findings suggest that extremely high HDL-C
levels are associated with an increase in the risk of mortality
and morbidity of cardiovascular disease. HDL-C may be a
double-edged sword for atherosclerosis. ...

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参考文献

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Table S1

HDL cholesterol and endothelial function

672.e1

Clinical characteristics in propensity score matched subjects

Variables

Age, y

Body mass index, kg/m2

Systolic blood pressure, mmHg

Diastolic blood pressure, mmHg

Heart rate, bpm

Total cholesterol, mg/dL

Triglycerides, mg/dL

HDL-C, mg/dL

LDL-C, mg/dL

Glucose, mg/dL

Medications, n (%)

Anti-hypertensive therapy

Anti-hyperglycemic therapy

Framingham risk score, %

Medical history, n (%)

Hypertension

Dyslipidemia

Diabetes mellitus

Current smokers

Previous cardiovascular disease

High 60–79 mg/dL

(n 5 451)

Extremely high $80 mg/dL

(n 5 451)

P value

51.4 6 11

22.1 6 2.6

129 6 17

81 6 12

63 6 11

216 6 32

84 (64, 109)

68 6 6

129 6 29

101 6 20

51.5 6 11

22.0 6 2.6

129 6 17

80 6 12

63 6 12

213 6 30

77 (58, 110)

91 6 11

105 6 28

100 6 17

.892

.623

.695

.239

.956

.138

.021

,.001

,.001

.500

98 (21.7)

19 (4.2)

4.0 6 3.5

104 (23.1)

18 (4.0)

3.1 6 3.4

.632

.867

,.001

200

165

29

127

12

203

86

24

131

16

.841

,.001

.479

.768

.442

(44.4)

(36.6)

(6.4)

(28.2)

(2.7)

(45.0)

(19.1)

(5.3)

(29.1)

(3.6)

HDL-C indicates high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol.

Data are presented as mean 6 SD or median (interquartile range).

Figure S1 Scatter plot shows the relationship between flowmediated vasodilation (FMD) and high-density lipoprotein cholesterol (HDL-C). Red line represents the estimated Lowest

smoothed curve.

Figure S2 Bar graphs show flow-mediated vasodilation (FMD)

in high levels of high-density lipoprotein cholesterol (HDL-C)

and in extreme high levels of HDL-C in propensity score matched

subjects. The error bars indicate the standard deviation.

...

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