Resumen de Role and predictive value of the hdl function for cardiovascular disease in a high risk population. Hdl function-linked markers and mechanisms
ABSTRACT Cardiovascular disease remains the first cause of death worldwide. Therefore, there is a growing interest in the study of novel surrogates to reduce the risk for future heart disease.
The aim of the present thesis was to evaluate the predictive role of a cluster of HDL-properties and components for cardiovascular diseases. To have an updated record of available literature in this field, we conducted a meta-analysis of observational studies. To assess the prognostic value for CVD of HDL-functionality and composition, we analyzed the cholesterol efflux capacity, HDL oxidative-inflammatory index, platelet activating factor acetylhydrolase activity and apolipoproteinA-I, A-IV, serum amyloid A, component Complement C3, and sphingosine-1-phosphate in samples of apolipoproteinB depleted plasma. Finally, to gain deeper knowledge of the mechanisms involved in the protective role hold by HDL, we analyzed the relationships among HDL function, LDL atherogenicity, and the 10-risk for cardiovascular disease according to FRAMINGHAM-REGICOR risk score and classical risk factors.
In summary, the meta-analysis study showed that CEC, and anti-inflammatory and antioxidant capacities of HDL, are inverse predictors of CVD. The association persisted for all-cause mortality risk with CEC and antioxidant capacity. These results were further confirmed in the case-cohort study nested within the PreDiMed cohort, in which cholesterol efflux capacity at baseline showed a strong and independent inverse association with the risk of ACS and AMI; ApoA-I predicted ACS, AMI, and US, and the HDL antioxidant/anti-inflammatory index proved to be a prognostic index for ACS and UA. Finally, high cardiovascular risk scores and classical risk factors for cardiovascular disease were associated with impaired HDL regarding its components, particle size, and function, and with an LDL more pro-atherogenic.
