High plasma cholesteryl ester transfer but not CETP mass predicts incident cardiovascular disease: A nested case control study

Objective: The relationship of cardiovascular disease (CVD) with plasma cholesteryl ester transfer protein (CETP) levels is controversial. We determined whether plasma cholesteryl ester transfer (CET), reflecting CETP-mediated transfer of cholesteryl esters from endogenous HDL towards apolipoprotein B-lipoproteins, predicts incident CVD. Methods: A prospective nested case-control study was carried out in 114 men who developed CVD and 105 controls. Participants did not use lipid lowering drugs at baseline. Plasma CET was assayed using an isotope method. Results: Plasma CET was 19% higher (P = 0.030), whereas CETP mass was unaltered (P = 0.30) in cases vs. controls. Plasma CET predicted CVD (age-adjusted hazard ratio (HR): 1.20(95% CI 1.02-1.46, P = 0.028), but incident CVD was unrelated to CETP mass (HR: 0.88(95% CI 0.73-1.07), P = 0.20). Plasma CET still predicted CVD after additional adjustment for total cholesterol/HDL cholesterol, triglycerides and non-lipid risk markers (HR: 1.22(95% CI 1.02-1.46, P = 0.031). Conclusion: Plasma CET rather than CETP mass may be a determinant of cardiovascular risk. (C) 2011 Elsevier Ireland Ltd. All rights reserved.