Cholesterol efflux capacity does not associate with coronary calcium, plaque vulnerability, and telomere length in healthy octogenarians

Francesca Zimetti,Wladimir M Freitas,Alessandra M Campos,Mauricio Daher,Maria Pia Adorni,Franco Bernini,Andrei C Sposito,Ilaria Zanotti

doi:10.1194/jlr.p079525

Francesca Zimetti, Wladimir M Freitas + Show 6 more

Open Access

https://doi.org/10.1194/jlr.p079525

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Abstract

Several studies have revealed that traditional risk factors are less effective in predicting CVD risk in the elderly, suggesting the need to identify new biomarkers. Here, we evaluated the association between serum cholesterol efflux capacity (CEC), an atheroprotective property of HDL recently identified as a novel marker of CVD risk, and atherosclerotic burden in a cohort of very old, healthy individuals. Serum CEC values were not significantly correlated either with calcium score or with markers of vulnerable plaque, such as positive remodeling, hypodensity, spotty calcification, or napking-ring sign. In addition, no association was detected between CEC and telomere length, a marker of biological aging that has been linked to atherosclerosis extent. Interestingly, elderly subjects presented a remarkably higher CEC (+30.2%; P < 0.0001) compared with values obtained from a cohort of sex-matched, cardiovascular event-free, middle-aged individuals. In conclusion, serum CEC is not related to traditional risk factors in very old, cardiovascular event-free subjects, but has significantly higher values compared with a healthy, younger population. Whether this improved HDL functionality may represent a protective factor in CVD onset must be established in future studies.

Highlights

Several studies have revealed that traditional risk factors are less effective in predicting CVD risk in the elderly, suggesting the need to identify new biomarkers
We recently reported that high LDL cholesterol (LDL-C) levels are not associated to subclinical coronary artery disease in healthy octogenarians [6] and results of a recent meta-analysis showed either a lack or an inverse association between LDL-C and both all-cause and CVD mortality at late-life age [7]
Compared with total cholesterol (TC), LDL-C, and nonHDL-C level in older age [8]. This concept is supported by studies that observed an inverse association between HDL cholesterol (HDL-C) levels and the risk of coronary artery disease or ischemic stroke in the elderly [9, 10], including a recent work in which we demonstrated that low HDL-C is independently associated with subclinical coronary atherosclerosis in a cohort of healthy octogenarians [6]

Summary

Introduction

Several studies have revealed that traditional risk factors are less effective in predicting CVD risk in the elderly, suggesting the need to identify new biomarkers. We evaluated the association between serum cholesterol efflux capacity (CEC), an atheroprotective property of HDL recently identified as a novel marker of CVD risk, and atherosclerotic burden in a cohort of very old, healthy individuals. Serum CEC is not related to traditional risk factors in very old, cardiovascular eventfree subjects, but has significantly higher values compared with a healthy, younger population. Whether this improved HDL functionality may represent a protective factor in CVD onset must be established in future studies.—Zimetti, F., W. Traditional lipid risk factors might be less effective in predicting CVD risk in the elderly compared with middle-aged individuals.

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