Cholesteryl ester transfer protein in patients with coronary heart disease

P>Background The impact of cholesteryl ester transfer protein (CETP) in the development of atherosclerosis is a matter for ongoing debate. In this study, we analyse associations of CETP with cardiovascular endpoints in a cohort of patients with stable coronary artery disease (CAD). Design KAROLA is a prospective observational study of patients with CAD and a median follow-up of 8 years (n = 1132). CETP levels were measured using an enzyme-linked immunosorbent assay. Results Cholesteryl ester transfer protein levels were lower in men (P = 0 center dot 0016), positively correlated to low-density lipoprotein cholesterol, and inversely correlated to triglyceride levels (P < 0 center dot 0001 and P = 0 center dot 011 respectively). There was no significant difference in mortality between patients in different CETP quartiles; the hazard ratio of lowest vs. highest quartile was 1 center dot 33 (95% confidence interval (CI): 0 center dot 77-2 center dot 30) for mortality and 1 center dot 24 (95% CI: 0 center dot 75-2 center dot 03) for secondary events. In post hoc analyses, comparing nondiabetic subjects with CETP below vs. above median, the adjusted hazard ratio for death in patients with low CETP levels was 1 center dot 84 (95% CI: 1 center dot 10-3 center dot 09). Conclusion Although statistically significant associations were found only in post hoc analyses, the effect sizes in this study were in line with previous findings in the Framingham and LURIC population. In combination, the emerging evidence challenges the concept of pharmacological CETP inhibition.