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Low-density lipoprotein in the setting of congestive heart failure: is lower really better?

Tamara Horwich1

  • 1Division of Cardiology, University of California, Los Angeles, CA 90095, USA. thorwich@mednet.ucla.edu

Current Atherosclerosis Reports
|August 12, 2009
PubMed

Insights

Hypercholesterolemia is a risk factor for coronary artery disease, but high cholesterol levels are linked to better survival in patients with heart failure (HF). Statin therapy for HF has not shown mortality benefits.

Area of Science:

  • Cardiology
  • Clinical Lipidology

Background:

  • Hypercholesterolemia is a known risk factor for coronary artery disease (CAD) and its complications.
  • Lipid-lowering therapy, particularly statins, effectively reduces HF risk in CAD patients.
  • However, in established heart failure (HF), hypercholesterolemia is paradoxically associated with improved survival.

Purpose of the Study:

  • To review the current evidence on the association between lipid levels and outcomes in patients with established heart failure.
  • To discuss the implications for lipid-lowering therapy in HF patients.

Main Methods:

  • Literature review of studies examining lipid profiles and mortality/morbidity in heart failure patients.
  • Analysis of data from large outcome trials investigating statin therapy in HF.

Main Results:

  • Higher levels of total cholesterol, LDL, HDL, and triglycerides correlate with better outcomes in HF, irrespective of etiology.
  • Large-scale trials have not demonstrated a mortality benefit from statin therapy in patients with established HF.

Conclusions:

  • The role of lipid-lowering therapy in patients with established heart failure remains controversial due to the observed association between higher lipid levels and improved survival.
  • Current evidence does not support routine statin use for mortality benefit in HF patients.

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