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Published on: October 12, 2017
High-density lipoprotein cholesterol levels and prognosis in advanced heart failure
Mandeep R Mehra1, Patricia A Uber, Carl J Lavie
1Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. mmehra@medicine.umaryland.edu
Insights
Lower high-density lipoprotein (HDL) levels predict worse outcomes in advanced heart failure (HF). This finding suggests HDL may be a key prognostic marker for clinical worsening or death in HF patients.
Area of Science:
- Cardiology
- Biochemistry
Background:
- High-density lipoproteins (HDLs) are known to influence prostacyclin generation.
- Prostaglandins play a role in advanced heart failure (HF).
- The prognostic significance of HDL levels in HF was previously unknown.
Purpose of the Study:
- To investigate the prognostic relationship between HDL levels and outcomes in patients with severe heart failure.
- To determine if HDL levels can predict clinical worsening or death in advanced HF.
Main Methods:
- Prospective evaluation of 132 patients with severe HF awaiting heart transplantation.
- Patients were grouped based on population mean HDL levels ( <33 mg/dl vs >=33 mg/dl).
- Follow-up for 18 months to assess composite endpoints of HF hospitalizations or death, stratified by HF etiology.
Main Results:
- Patients with lower HDL (<33 mg/dl) exhibited distinct biochemical profiles, including lower serum sodium and higher total bilirubin and uric acid.
- Reduced HDL levels (<33 mg/dl) were identified as the most significant independent predictor of HF hospitalizations or death.
- Low levels of total cholesterol and low-density lipoprotein (LDL)-cholesterol were not independently predictive of outcomes.
Conclusions:
- Lower HDL levels are associated with an adverse prognosis in advanced HF, independent of the underlying cause.
- These findings suggest that HDL levels may serve as a clinical marker for predicting adverse events in HF.
- Further research is needed to explore HDL as a potential therapeutic target in advanced HF.
Background:
High-density lipoproteins (HDLs) influence the generation of prostacyclin via cyclooxygenase stimulation. Prostaglandins represent an important compensatory pathway in advanced heart failure (HF). Whether HDL levels discriminate prognosis in HF remains unknown.
Methods:
We prospectively evaluated the prognostic relationship of HDL levels in severe HF by examining 132 consecutive patients listed for heart transplantation (52 +/- 11 years of age, 80% men, 79% white, mean follow-up 18 months). Using population mean HDL levels (HDL <33 mg/dl [n = 47] vs > or =33 mg/dl [n = 85]), patients were grouped and followed for the primary composite end-points of HF hospitalizations or death, stratified by underlying etiology (non-ischemic, n = 52; ischemic, n = 80).
Results:
Patients with HDL <33 mg/dl had lower serum sodium (135 vs 137 mEq/liter, p = 0.008), higher total bilirubin (1.3 vs 0.7 mg/dl, p < 0.001) and higher uric acid (7.6 vs 6.7 mg/dl, p = 0.048) levels, but similar serum creatinine compared with the > or =33 mg/dl HDL group. Survival analysis, using a Cox proportional hazards model, revealed reduced HDL (<33 mg/dl) as the most significant independent predictor of HF hospitalizations or death, independent of underlying etiology. Low-cholesterol and low-density lipoprotein (LDL)-cholesterol alone were not found to be independently predictive of outcome.
Conclusions:
Lower HDL levels correlate with adverse prognosis independent of etiology and predict clinical worsening or death in advanced HF. Further study is warranted as to whether these findings represent a clinical marker or suggest a potential therapeutic target.
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