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Total cholesterol level decrease predicts higher mortality in chronic heart failure
Mariana Matos1, Ana Neves1, Sérgio Madureira1
1Service of Internal Medicine, São João University Hospital, Porto, Portugal.
Insights
A significant decrease in total cholesterol (TC) levels in heart failure patients is linked to increased mortality risk. This finding questions the use of statins in heart failure management.
Area of Science:
- Cardiology
- Clinical Research
- Biomarkers
Background:
- Lower total cholesterol (TC) is associated with adverse outcomes in heart failure (HF).
- The prognostic significance of TC variation in HF patients remains unclear.
- Understanding TC dynamics is crucial for HF management.
Purpose of the Study:
- To investigate the impact of TC variation on mortality in patients with chronic heart failure.
- To determine if a decrease in TC levels predicts poor outcomes in HF.
- To evaluate the association between TC changes and all-cause mortality.
Main Methods:
- Retrospective analysis of adult outpatients with chronic HF and systolic dysfunction (2012-2020).
- TC variation calculated as percentage change from baseline to 1-year follow-up.
- Cox-regression analysis used to assess mortality risk associated with a TC decrease of ≥10%.
Main Results:
- A total of 362 patients were analyzed; 35.1% experienced a ≥10% decrease in TC within the first year.
- Patients with a ≥10% TC decrease had a higher mortality rate (41.7% vs. 32.8%).
- Multivariate analysis revealed an independent 71% increased risk of all-cause death (HR 1.71) for patients with ≥10% TC decrease.
Conclusions:
- A ≥10% decrease in TC independently predicts a significantly higher risk of mortality in heart failure patients.
- These findings support the 'cholesterol paradox' in HF.
- The results raise questions about the efficacy and safety of statin therapy in this population.
Background:
In heart failure (HF), lower total cholesterol (TC) levels associate with poor outcomes. Whether TC variations portend prognostic implication is unknown. We aimed to evaluate the impact of TC variation in HF.
Methods:
We retrospectively analyzed adult outpatients with chronic HF with systolic dysfunction evaluated between January/2012 and December/2020. Patients with no TC measurement at baseline or at the 1-year follow-up visit were excluded. Variation of TC during the first year = [(baseline TC - TC at the 1-year visit)/baseline TC] × 100. Patients were followed-up until five years after the first-year visit. Endpoint: all-cause mortality. A Cox-regression analysis was performed to assess the association of TC variation (cutoff ≥10% decrease) with mortality. A multivariate model was built.
Results:
We studied 362 patients, 67.4% male, mean age 69 years, 42.8% presented severe systolic dysfunction; 69.6% were on statin therapy. TC level decreased during the first year: 173 (47) vs. 166 (45) mg/dL respectively (P=0.002). In 127 (35.1%) patients there was a ≥10% decrease in TC. During a median follow-up of 57 (31-60) months, 130 (35.9%) patients died: 41.7% in those with a ≥10% TC decrease versus 32.8% in the remaining (P=0.09). Patients with at least 10% decrease in TC had higher mortality risk, after a multivariate adjustment the HR of all-cause death was 1.71 (1.15-2.55, P=0.008).
Conclusions:
Patients with ≥10% decrease in TC had an independent 71% increase in the risk of death. Our results reinforce the cholesterol paradox and further question the use of statins in HF.
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