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Published on: November 17, 2018
A longitudinal 20 years of follow up showed a decrease in the survival of heart failure patients who maintained low
G Charach1, O Argov1, H Nochomovitz1
1From the Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel.
Insights
In advanced heart failure (HF), low low-density lipoprotein cholesterol (LDL-c) levels are linked to higher mortality, especially in younger patients on statins. This challenges aggressive LDL-c reduction in this population.
Area of Science:
- Cardiology
- Clinical Research
Background:
- Statins are standard for cardiovascular event prevention but may harm heart failure (HF) patients.
- The safety and efficacy of statin therapy in HF remain debated.
Purpose of the Study:
- To investigate the long-term association between baseline low-density lipoprotein cholesterol (LDL-c) and clinical outcomes in severe heart failure (HF).
Main Methods:
- A 20-year observational study involving 305 advanced HF patients (average NYHA score 2.7).
- Patients were stratified by baseline LDL-c levels: ≤110 mg/dl (Group 1) and >110 mg/dl (Group 2).
- Mean follow-up was 11.3 years, with a 43% all-cause mortality rate.
Main Results:
- A paradoxical association was observed: higher baseline LDL-c levels correlated with improved outcomes and lower mortality.
- Conversely, the lowest LDL-c levels were associated with the highest mortality rates.
- This effect was more pronounced in patients under 70 years old and those treated with statins.
Conclusions:
- Low LDL-c levels may indicate a poorer prognosis in advanced HF, particularly in younger patients (<70 years) and those on statin therapy.
- Aggressive LDL-c-lowering strategies may be detrimental in younger HF patients.
- Findings suggest a re-evaluation of lipid management guidelines for specific HF populations.
Background:
Treatment by statins is well established for primary and secondary prevention of cardiac events but may be hazardous for patients with heart failure (HF).
Aim:
We studied the long-term (20 years) association between baseline low-density lipoprotein cholesterol (LDL-c) levels and clinical outcome in patients with severe HF.
Design:
Patients were divided into those with plasma LDL-c levels 110 mg/dl (Group 1) or >110 mg/dl (Group 2).
Methods:
The mean follow-up of 305 study patients with advanced HF who had an average NYHA score of 2.7 was 11.3 years (range 15 months to 20 years). Mortality during follow-up was 43%.
Results:
Patients with the highest baseline LDL-c levels had significantly improved outcome, whereas those with the lowest LDL-c levels had the highest mortality. This paradoxical effect was prominent in patients <70 years old. The negative association of LDL-c levels and mortality was most conspicuous among the HF patients who were treated with statins.
Discussion And Conclusion:
Long-term follow-up findings showed that low LDL-c levels may predict a less favorable outcome in advanced HF, particularly in patients <70 years old and those taking statins. This negates the protocol of following an aggressive LDL-c-lowering strategy in younger patients with HF.
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