Impact of low cholesterol efflux

Cholesterol efflux is the first step in removing excess cholesterol from plaque in the arterial wall. An alternative approach is to consider the role of efflux in protecting against increasing plaque build up in the arteries.1,2

Atherosclerotic plaque build up over time

Atherosclerosis causes clinical disease through luminal narrowing, affecting blood flow to the heart, brain or lower extremities.3

Atherosclerotic plaque may occur at multiple sites in the arterial tree, which increases the risk of recurrent CV events in the first year after an AMI.3–7

Atherosclerosis begins as a fatty streak within the arterial wall which develops due to an imbalance between cholesterol influx and efflux.3–7

This fatty streak gradually thickens to form an atherosclerotic plaque.7

Some of the common reasons for an AMI include plaque rupture, blood clot formation at the site, or block of blood flow through the coronary artery.7

Adapted from Pepine et al. 19988 and Rader and Daugherty 20087


Plaque rupture

Compromised efflux causes cholesterol build up

Any imbalance between cholesterol influx and efflux will allow atherosclerotic plaque to become engorged with excess cholesterol, making them vulnerable to rupture.2,8–12

The integrity of the fibrous cap overlying the lipid-rich core determines the stability of an atherosclerotic plaque, and reducing the lipid core may improve stability.13,14

Adapted from Libby 199513


Recurrent CV events are just as likely to originate from an existing non-culprit lesion as they are from the initial culprit lesion.3,15–17

Low cholesterol efflux is associated with greater CV risk


Clinically, a strong association exists between low cholesterol efflux and greater risk of a fatal CV event or a non-fatal AMI or stroke independent of HDL-cholesterol.18–24

The Dallas Heart Study, a population-based cohort of 2,924 adults free from cardiovascular disease at baseline, showed those with low cholesterol efflux are about six times more likely to die due to incidence of CV events compared with those with high cholesterol efflux (median follow-up of 9.4 years).19

High cholesterol efflux is associated with lower CV risk

In a meta-analysis of 20 clinical trials, high cholesterol efflux was associated with a 37% lower risk of adverse cardiovascular events compared with low cholesterol efflux.24 

In the pivotal ePARIS registry, a prospective study of 1,609 consecutive patients treated for an AMI, patients with high cholesterol efflux had a 68% lower risk of mortality compared with patients with low cholesterol efflux.22


Continue to

What happens to cholesterol efflux after an AMI?

Learn about why patients are at a disproportionately high risk in the 90-day period post AMI19,20,22,25,26

Burden of recurrent CV events

Find out about the significant healthcare costs associated with recurrent CV events post AMI27–30

Current standard of care post AMI

Current standard of care and newer therapies have lowered the long-term risk of recurrent CV events; however, data show that patients are still at risk during the 90-day high-risk period after an AMI31–38

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AMI, acute myocardial infarction; CV, cardiovascular; HDL, high-density lipoprotein; LDL, low-density lipoprotein


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USA-GEN-0051 | August 2023