Heart failure
Baseline Low-Density Lipoprotein Cholesterol Levels and Outcome in Patients With Heart Failure

https://doi.org/10.1016/j.amjcard.2009.08.660Get rights and content

The incidence of heart failure (HF) is constantly increasing in the Western world. Treatment with statins is well established for the primary and secondary prevention of cardiac events by lowering low-density lipoprotein (LDL) cholesterol levels. There are conflicting reports on the role of LDL cholesterol as an adverse prognostic predictor in patients with advanced HF. The aim of this study was to investigate the association between LDL cholesterol levels and clinical outcomes in 297 patients with severe HF (average New York Heart Association class 2.8). The mean follow-up period was 3.7 years (range 8 months to 11.5 years), and 37% of the patients died during follow-up. The mean time to first hospital admission for HF was 25 ± 17 months. The study group was divided according to plasma LDL level ≤89, >89 to ≤115, >115 mg/dl. Patients with the highest baseline LDL cholesterol levels had significantly improved outcomes, whereas those with the lowest LDL cholesterol levels had the highest mortality. When analyzed with respect to statin use, it emerged that the negative association between LDL cholesterol level and mortality was present only in the patients with HF who were treated with statins. In conclusion, lower LDL cholesterol levels appear to predict less favorable outcomes in patients with HF, particularly those taking statins, raising questions about the need for aggressive LDL cholesterol–lowering strategy in patients with HF, regardless of its cause.

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Methods

All the patients in this prospective study were recruited from the special HF unit at Tel Aviv Sourasky Medical Center. Baseline blood samples for lipid profiles, renal function tests, and hemoglobin levels were obtained from January 2000 to July 2001. Consecutive patients with HF were enrolled. Systolic HF was defined as a left ventricular ejection fraction <40%16 by echocardiography. At their first visits, all participants were examined by physicians, and the following information was

Results

A total of 324 consecutive outpatients with congestive HF–related symptoms were eligible for participation in this prospective study according to the exclusion and inclusion criteria. Twenty-seven were excluded for technical reasons, noncompliance, or a lack of follow-up information. The remaining 297 patients constituted the study cohort. Their mean follow-up duration was 3.7 years (range 8 months to 11.5 years). The general characteristics of the study patients are listed in Table 1. Their

Discussion

We designed this study to determine whether baseline LDL cholesterol levels could serve as a prognostic predictor in patients with severe but clinically controlled HF who were or were not receiving statin treatment. Our results showed that low baseline LDL cholesterol levels (i.e., <70 mg/dl) were a significant predictor of worse outcomes in patients with ischemic HF and those with nonischemic HF. Even after adjusting for multiple known predictors of HF mortality, a high LDL cholesterol level

Acknowledgment

We thank Esther Eshkol for editorial assistance.

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