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
Compromised efflux causes cholesterol build up
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
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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