High cholesterol absorption efficiency increases the risk of the nonfatal and fatal atherosclerotic events

The aim of this study was to investigate whether cholesterol metabolism, especially high cholesterol absorption, affects atherosclerotic event risk in acute coronary syndrome (ACS) versus control patients without coronary artery disease (CAD). We set up a randomized, case-control substudy of a Corogene cohort (total cohort 5,295 consecutive patients admitted for coronary angiography because of stable or atypical chest pains and followed up for a median of 9.5 [interquartile range, 8.9-10.0] years). Of these, 200 ACS patients were matched by sex, age, BMI, LDL-C, and serum triglycerides to 200 patients without CAD. Blood samples were available in 363 cases (study population: ACS, n = 168; no CAD, n = 195) for analysis of serum biomarkers of relative cholesterol metabolism. High cholesterol absorption was associated with nonfatal and fatal acute CAD events in the ACS group but not in the no CAD group, whereas good compliance with statin treatment during the follow-up and low LDL-C concentration associated with good prognosis. Patients with high cholesterol absorption showed the worst survival probability during the follow-up, whereas individuals with low cholesterol absorption showed the best survival probability. In conclusion, high cholesterol absorption was associated with nonfatal and fatal acute CAD events in the ACS group in this exploratory clinical study. Individuals with high cholesterol absorption had more atherosclerotic events during the follow-up period, and their survival rate was worse than that of those with low cholesterol absorption. With therapy lowering both cholesterol absorption and LDL-C concentrations, cholesterol metabolism can be modified to become less atherogenic.