High-density lipoprotein cholesterol efflux capacity and cardiovascular risk in autoimmune and non-autoimmune diseases

Functional assessment of cholesterol efflux capacity (CEC) to high-density lipoprotein (HDL) is an emerging tool for evaluating morbidity and mortality associated with cardiovascular disease (CVD). By promoting macrophage reverse cholesterol transport (RCT), HDL-mediated CEC is believed to play an important role in atherosclerotic lesion progression in the vessel wall. Furthermore, recent evidence indicates that the typical inverse associations between various forms of CEC and CV events may be strongly modulated by environmental systemic factors and traditional CV risk factors, in addition to autoimmune diseases. These factors influence the complex and dynamic composition of HDL particles, which in turn positively or negatively affect HDL-CEC. Herein, we review recent findings connecting HDL-CEC to traditional CV risk factors and cardiometabolic conditions (non-autoimmune diseases) as well as autoimmune diseases, with a specific focus on how these factors may influence the associations between HDL-CEC and CVD risk. •Autoimmune/non-autoimmune diseases influence the composition and function of HDL.•Inflammation impedes the straightforward interpretation of ABCA1-cholesterol efflux.•The impact of smoking/gender/aging on ABCA1/ABCG1 efflux role remains inconclusive.•Diabetes and autoimmune diseases may alter ABCA1/ABCG1 cholesterol efflux function.•ABCA1-cholesterol efflux and CV risk in obesity or MetS remains controversial.