Date of Award

Spring 12-2019

Degree Name

Master of Public Health (MPH)



Second Advisor


Third Advisor



Metabolic syndrome (MetS) is a multi-component risk factor for cardiovascular disease (CVD) and type 2 diabetes. MetS has been found to be associated with increased risk of incident CVD, cardiovascular morbidity and mortality, and prevalence atherosclerosis. Cholesterol efflux capacity (CEC) is a measure of the functional property of high-density lipoprotein cholesterol (HDL-C). In addition, it characterizes the ability of HDL-C to accept cholesterol from extra-hepatic cells in the periphery to the liver and has been shown in clinical studies to be inversely associated with atherosclerosis cardiovascular disease (ASCVD) and incident cardiovascular disease (CVD) . Low HDL-C is one of the components of MetS and it is important to understand how the functionality of HDL captured through CEC is affected in MetS. The aim of this study was to evaluate the association between CEC and MetS in a multi-ethnic population. In addition, the results obtained based on the labeled cholesterol used in the efflux assay were compared for similarities and differences. A cross-sectional study was performed using data obtained from participants at the entry into Dallas Heart Study phase 2 (DHS 2). DHS 2 is a subset of participants from DHS 1, a multiethnic probability-based cohort study of Dallas County residents supplemented by recruitment of participants’ spouses or significant others. Multivariate regression analyses were performed to assess the relationship between CEC and MetS. A total of 2942 participants were included in the study. The mean age was 49.4 years. A total of 40% of the participants were men and 52% were non-Hispanic Black. CEC measured using radiolabeled cholesterol was found to be inversely associated with MetS in the unadjusted model (odds ratio per 1-SD 0.86; 95%CI 0.80 – 0.93; P=0.0002). This finding remained significant after adjusting for demographics, modifiable risk factors, lipids, post menopausal status, and history of cardiovascular disease. CEC measured using fluorescent labeled cholesterol was not significantly associated with MetS in the unadjusted model, but significant after adjusting for lipids (low-density lipoprotein cholesterol and very low-density lipoprotein cholesterol) (adjusted odds ratio per 1-SD 0.82; 95%CI 0.73 – 0.93; P=0.0013). There was an inverse relationship between cholesterol efflux capacity, irrespective of the labeled cholesterol used in the efflux assay, and metabolic syndrome. With the observed association between cholesterol efflux capacity and metabolic syndrome, cholesterol efflux capacity can serve as a marker to predict metabolic syndrome and to understand the functionality of HDL-C in metabolic syndrome, ultimately allowing for early detection and intervention in reducing the risk of cardiovascular disease.