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Clin Nutr. 2014 Oct;33(5):815-22. doi: 10.1016/j.clnu.2013.10.020. Epub 2013 Nov 1.

Serum total and high-density lipoprotein phospholipids: independent predictive value for cardiometabolic risk.

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  • 1Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey. Electronic address:
  • 2Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
  • 3Department of Public Health, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
  • 4Department of Cardiology, Dicle University, Diyarbakir, Turkey.
  • 5S. Ersek Center for Cardiovascular Surgery, Istanbul, Turkey.



Given that serum phospholipids (PL) may serve as inflammation mediators, we studied whether they predicted metabolic syndrome (MetS), type-2 diabetes or coronary heart disease (CHD) risk in people prone to enhanced low-grade inflammation.


We analyzed unselected middle-aged Turkish adults with available serum total (n = 852) and HDL-PL (n = 428) measurements and follow-up (mean 6.6 years) by Cox or logistic regression, after exclusion of prevalent cases of outcome disorder. The enzymatic method used measured total content of phosphatidylcholine, sphingomyelin and lyso-phosphatidylcholine.


Most lipid and non-lipid variables were significantly different in the upper two compared with the lowest total PL tertile, whereby apolipoprotein (apo)A-I and HDL-cholesterol were higher (not lower). ApoA-I, HDL-cholesterol and uric acid were uniformly positive independent linear covariates of total and HDL PL, apoA-I even in participants without MetS. After adjustment for sex, age, waist circumference, HDL-cholesterol and systolic blood pressure, logistic regression for incident MetS disclosed a 3-fold risk (RR [95% CI 1.28; 6.81]) in the upper HDL-pl tertile. In Cox regression models, while the combined two higher HDL-pl tertiles significantly protected against CHD risk in males (HR 0.29 [95% CI 0.10; 0.89]), they weakly tended to impart risk in females: upper two total PL tertiles tended to increased risk of diabetes and CHD.


Excess total PL may mediate inflammatory properties to apoA-I, HDL and uric acid. Excess HDL-pl independently predict risk for MetS in each gender, but are protective against CHD risk in men, possibly because oxidized PL content mediated by total PL is sex-dependent, as reviewed elsewhere.

Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.


Apolipoprotein A-I; Coronary heart disease risk; HDL-cholesterol; Metabolic syndrome; Phospholipids; Population-based study

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