Impaired HDL cholesterol efflux in metabolic syndrome is unrelated to glucose tolerance status: the CODAM study

Sci Rep. 2016 Jun 8;6:27367. doi: 10.1038/srep27367.


Type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) increase atherosclerotic cardiovascular disease risk. Cholesterol efflux capacity (CEC) is a key metric of the anti-atherosclerotic functionality of high-density lipoproteins (HDL). The present study aimed to delineate if T2DM and MetS cross-sectionally associate with altered CEC in a large high cardiometabolic risk population. CEC was determined from THP-1 macrophage foam cells towards apolipoprotein B-depleted plasma from 552 subjects of the CODAM cohort (288 controls, 126 impaired glucose metabolism [IGM], 138 T2DM). MetS was present in 297 participants. CEC was not different between different glucose tolerance categories but was lower in MetS (P < 0.001), at least partly attributable to lower HDL cholesterol (HDL-C) and apoA-I levels (P < 0.001 for each). Low grade inflammation was increased in IGM, T2DM and MetS as determined by a score comprising 8 different biomarkers (P < 0.05-< 0.001; n = 547). CEC inversely associated with low-grade inflammation taking account of HDL-C or apoA-I in MetS (P < 0.02), but not in subjects without MetS (interaction: P = 0.015). This study demonstrates that IGM and T2DM do not impact the HDL CEC function, while efflux is lower in MetS, partly dependent on plasma HDL-C levels. Enhanced low-grade inflammation in MetS may conceivably impair CEC even independent of HDL-C and apoA-I.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Apolipoprotein A-I / blood
  • Apolipoproteins B / blood
  • Biological Transport / physiology
  • Cholesterol / adverse effects*
  • Cholesterol / metabolism*
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / pathology*
  • Female
  • Foam Cells / pathology
  • Glucose / metabolism
  • Glucose Intolerance / pathology*
  • Glycated Hemoglobin A / analysis
  • Humans
  • Inflammation / pathology
  • Lipoproteins, HDL / blood
  • Male
  • Metabolic Syndrome / pathology*
  • Triglycerides / blood


  • Apolipoprotein A-I
  • Apolipoproteins B
  • Glycated Hemoglobin A
  • Lipoproteins, HDL
  • Triglycerides
  • hemoglobin A1c protein, human
  • Cholesterol
  • Glucose