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Predictive value of remnant cholesterol level for all-cause mortality in heart failure patients
Lang Zhao1,2, Xuemei Zhao2, Pengchao Tian2
1Department of Emergency, China-Japan Friendship Hospital, Beijing, China.
Insights
Lower remnant cholesterol levels are linked to higher mortality in heart failure (HF) patients. This study found that remnant cholesterol improves risk prediction for HF mortality.
Area of Science:
- Cardiology
- Metabolic Syndrome
- Clinical Research
Background:
- Lower cholesterol levels are paradoxically associated with increased mortality in heart failure (HF) patients.
- Remnant cholesterol, encompassing all cholesterol outside of HDL and LDL, has an unknown prognostic role in HF.
- Understanding remnant cholesterol's impact is crucial for managing HF patients.
Purpose of the Study:
- To investigate the relationship between baseline remnant cholesterol levels and all-cause mortality in patients with heart failure.
- To determine if remnant cholesterol can serve as a prognostic marker in HF.
- To assess the incremental predictive value of remnant cholesterol in HF mortality risk stratification.
Main Methods:
- A cohort of 2,823 patients hospitalized for HF was analyzed.
- Kaplan-Meier analysis and Cox regression models were employed to assess mortality risk.
- C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate prognostic refinement.
Main Results:
- The lowest mortality rate was observed in the highest quartile of remnant cholesterol.
- Increased remnant cholesterol levels were significantly associated with decreased all-cause mortality risk (adjusted HR: 0.59).
- Adding remnant cholesterol quartile to traditional risk factors improved risk prediction models (ΔC-statistic, NRI, IDI all significant).
Conclusions:
- Low remnant cholesterol levels are associated with increased all-cause mortality in heart failure patients.
- Remnant cholesterol quartile significantly improves the predictive value for mortality beyond traditional risk factors in HF.
- Remnant cholesterol is a valuable prognostic marker for heart failure patients.
Background:
Lower cholesterol levels are associated with increased mortality in heart failure (HF) patients. Remnant cholesterol corresponds to all cholesterol not found in high-density lipoprotein (HDL) and low-density lipoprotein (LDL). The prognostic role of remnant cholesterol in HF remains unknown.
Objective:
To reveal the relationship between the baseline remnant cholesterol level and all-cause mortality in HF patients.
Methods:
This study enrolled 2,823 patients hospitalized for HF. Kaplan-Meier analysis, Cox regression, C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the prognostic value of remnant cholesterol for all-cause mortality in HF.
Results:
The mortality rate was lowest in the fourth quartile of remnant cholesterol, which had an adjusted hazard ratio (HR) for death of 0.56 [HR: 0.39, 95% confidence interval (CI): 0.46-0.68, p < 0.001] relative to the first quartile. After adjustment, a one-unit increase in the level of remnant cholesterol was associated with a 41% decrease in the risk of all-cause mortality (HR: 0.59, 95% CI: 0.47-0.73, p < 0.001). A refinement in risk prediction was observed after adding remnant cholesterol quartile to the original model (ΔC-statistic = 0.010, 95% CI: 0.003-0.017; NRI = 0.036, 95% CI: 0.003-0.070; IDI = 0.025, 95% CI: 0.018-0.033; all p < 0.05).
Conclusion:
Low remnant cholesterol levels are associated with increased all-cause mortality in HF patients. The addition of the remnant cholesterol quartile improved the predictive value over traditional risk factors.
Clinical Trial Registration:
ClinicalTrials.gov, Unique Identifier: NCT02664818.
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