Cholesterol efflux capacity does not associate with coronary calcium, plaque vulnerability and telomere length in healthy octogenarians

Several studies revealed that traditional risk factors are less effective in predicting CVD risk in the elderly, suggesting the need to identify new biomarkers. Here we evaluated the association between serum cholesterol efflux capacity (CEC), an atheroprotective property of HDL recently identified as a novel marker of CVD risk, and atherosclerotic burden in a cohort of very old, healthy individuals. Serum CEC values were not significantly correlated neither with calcium score nor with markers of vulnerable plaque, such as positive remodeling, hypodensity, spotty calcification or napking-ring sign. In addition, no association was detected between CEC and telomere length, a marker of biological aging that has been linked to atherosclerosis extent. Interestingly, elderly subjects presented a remarkably higher CEC (+30.2%; p<0.0001) compared to values obtained from a cohort of sex-matched, free of cardiovascular events, middle-aged individuals. In conclusion, serum CEC is not related to traditional risk factors in very old, free of cardiovascular events subjects, but has significantly higher values compared to a healthy, younger population. Whether this improved HDL functionality may represent a protective factor in CVD onset has to be established in further studies.