Elevated CETP activity during acute STEMI independently predicts endothelial dysfunction and 12.8-fold higher 30-day mortality risk (Atherosclerosis 2014)

Original title: Elevated CETP activity during acute phase of myocardial infarction is independently associated with endothelial dysfunction and adverse clinical outcome

Atherosclerosis · 4 November 2014 · 8

Carvalho LS, Virginio VW, Panzoldo NB, Figueiredo VN, Santos SN, Modolo RG, Andrade JM, Quinaglia E Silva JC, Nadruz-Junior W, de Faria EC, Sposito AC, Brasilia Heart Study Group

In 116 consecutive patients with ST-elevation myocardial infarction followed for 180 days, plasma cholesteryl ester transfer protein (CETP) activity was measured alongside inflammatory and oxidative markers, flow-mediated dilation (FMD), and coronary thrombus burden. Neither baseline nor the early change in CETP activity was associated with inflammatory markers or thrombus burden, but patients with baseline CETP activity above the median had an inferior rise in nitric oxide [3.5(-1; 10) vs. 5.5(-1; 12); p < 0.001] and lower FMD [5.9(5.5) vs. 9.6(6.6); p = 0.047]. The change in oxidized HDL content was associated with CETP activity (r = 0.72; p = 0.014) and with FMD (r = -0.61; p = 0.046). High admission CETP activity was associated with sudden death and recurrent myocardial infarction at 30 days (OR 12.8; 95% CI 1.25-132; p = 0.032) and 180 days (OR 3.3; 95% CI 1.03-10.7; p = 0.044).

Original abstract

Objective: Recent data suggests that cholesteryl ester transfer protein (CETP) activity may interact with acute stress conditions via inflammatory-oxidative response and thrombogenesis. We investigated this assumption in patients with ST-elevation myocardial infarction (STEMI).

Methods: Consecutive patients with STEMI (n = 116) were enrolled <24-h of symptoms onset and were followed for 180 days. Plasma levels of C-reactive protein (CRP), interleukin-2 (IL-2), tumor necrosis factor (TNFα), 8-isoprostane, nitric oxide (NOx) and CETP activity were measured at enrollment (D1) and at fifth day (D5). Flow-mediated dilation (FMD) was assessed by ultrasound and coronary thrombus burden (CTB) was evaluated by angiography.

Results: Neither baseline nor the change of CETP activity from D1 to D5 was associated with CRP, IL-2, TNFα, 8-isoprostane levels or CTB. The rise in NOx from D1 to D5 was inferior [3.5(-1; 10) vs. 5.5(-1; 12); p < 0.001] and FMD was lower [5.9(5.5) vs. 9.6(6.6); p = 0.047] in patients with baseline CETP activity above the median value than in their counterparts. Oxidized HDL was measured by thiobarbituric acid reactive substances (TBARS) in isolated HDL particles and increased from D1 to D5, and remaining elevated at D30. The change in TBARS content in HDL was associated with CETP activity (r = 0.72; p = 0.014) and FMD (r = -0.61; p = 0.046). High CETP activity at admission was associated with the incidence of sudden death and recurrent MI at 30 days (OR 12.8; 95% CI 1.25-132; p = 0.032) and 180 days (OR 3.3; 95% CI 1.03-10.7; p = 0.044).

Conclusions: An enhanced CETP activity during acute phase of STEMI is independently associated with endothelial dysfunction and adverse clinical outcome.

Summary written by cetpinhibition.org from the published abstract; figures as published. Page updated 19 August 2026. Methods.