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Low serum total cholesterol is associated with marked increase in mortality in advanced heart failure
Tamara B Horwich1, Michele A Hamilton, W Robb Maclellan
1UCLA Department of Medicine, Los Angeles, California, USA.
Insights
Low total cholesterol (TC) is linked to worse outcomes in advanced heart failure (HF). Higher TC levels correlated with better survival, suggesting TC is a novel prognostic factor in HF patients.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Hypercholesterolemia is a known risk factor for coronary artery disease.
- The link between cholesterol and heart failure (HF) is understudied.
Purpose of the Study:
- To investigate the relationship between serum cholesterol levels and prognosis in advanced heart failure (HF).
Main Methods:
- Measured cholesterol and lipoproteins in 1,134 advanced HF patients.
- Stratified patients into quintiles based on total cholesterol (TC) levels.
- Analyzed patient characteristics and survival differences across TC quintiles.
Main Results:
- Lower TC was associated with lower LDL, HDL, TG, albumin, and reduced cardiac function.
- TC, LDL, HDL, and TG independently predicted survival, with higher levels indicating better outcomes.
- After risk adjustment, lower TC quintiles showed significantly increased mortality risk.
Conclusions:
- Serum total cholesterol (TC) is a novel prognostic indicator in advanced heart failure (HF).
- Further research is needed to explore the role of low cholesterol in HF progression.
Background:
Although hypercholesterolemia is a well-defined risk factor for morbidity and mortality in coronary artery disease, the relationship between cholesterol and heart failure (HF) has rarely been investigated.
Methods:
Cholesterol and lipoproteins were measured in 1,134 patients with advanced HF who presented to a single center for HF management and transplant evaluation. Patients were stratified into five groups based on quintiles of total cholesterol (TC) level, and differences in patient characteristics and survival were evaluated.
Results:
Patients with low TC had significantly lower low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides (TG), sodium, albumin, left ventricular ejection fraction, and cardiac output. The TC quintiles were similar in terms of HF etiology, hypertension, diabetes, and lipid-lowering therapy at time of referral. TC, LDL, HDL, and TG each predicted survival (P < or = .01) on univariate analysis, with improved survival at higher levels. After adjustment for risk factors using a Cox proportional hazards model, relative risks were 2.071, 1.369, 1.391, 1.006 for the first, second, third, and fourth TC quintiles, with quintile 5 as reference.
Conclusions:
Serum TC represents a novel prognostic factor for patients with advanced HF. Further studies are necessary to investigate a potential role of low cholesterol and lipoproteins in the pathophysiology of HF progression.