Low Levels of Low-Density Lipoprotein Cholesterol: A Negative Predictor of Survival in Elderly Patients with Advanced Heart Failure

Abstract

Objectives: There are conflicting reports on the role of cholesterol as an adverse prognostic predictor in patients with heart failure (HF). This study aimed to examine the impact of low levels of low-density lipoprotein cholesterol (LDL-c) on cardiac mortality in a cohort of elderly patients with moderate and severe HF. Methods: Chronic HF patients from the HF Unit at the Tel-Aviv Medical Center (n = 212, 77% males) with an average NYHA classification of 2.8, a mean age of 76.9 ± 7.3 years (range 66-91) and a mean follow-up of 3.7 years were consecutively enrolled. The cohort was divided into tertiles according to LDL-c levels: LDL <90 mg/dl (group 1), LDL 90-115 mg/dl (group 2) and LDL >115 mg/dl (group 3). Results: The Cox regression analysis revealed that group 3 patients had the best outcome (p = 0.01 vs. groups 2 and 3), with 58% of them surviving longer than 50 months compared to 34% in group 1. The same trend was seen in the group of patients suffering from ischemic cardiomyopathy and in patients who were treated by statins (p = 0.04). Conclusion: Low LDL-c levels are associated with a reduced survival in elderly patients with clinically controlled moderate and severe HF.

Exploring the Lipid Paradox Theory in Rheumatoid Arthritis: Associations of Low Circulating Low‐Density Lipoprotein Concentration With Subclinical Coronary Atherosclerosis

“…However, whether these or other mechanisms mediate the low LDL phenotype to be proatherogenic warrants further investigation. Very low LDL concentrations, along with lower HDL concentrations and triglyceride levels, have also been linked to higher mortality in patients with moderate‐to‐severe heart failure . Whether this phenomenon is due to an increase in atherosclerosis, consistent with our findings, or is a consequence of malnutrition and/or the cachectic hypermetabolic state of advanced heart failure is unclear.…”

Red blood cell distribution width and myocardial scar burden in coronary artery disease

“…A number of studies have shown that MPV is associated with cardiovascular risk factors and is a prognosticator of cerebrovascular events. It has been demonstrated recently that a low LDL-cholesterol level is a poor prognosticator in patients with chronic HF 29. This is the case in our study population where the median ejection fraction was 31%, representing severely impaired LV function.…”

Prognostic Impact of Statin Intensity in Heart Failure Patients With Ischemic Heart Disease: A Report From the CHART‐2 (Chronic Heart Failure Registry and Analysis in the Tohoku District 2) Study

“…This finding on the J-curve relationship between LDL-C levels and outcomes is important because it indicates that lower LDL-C levels under statin treatments do not necessarily relate to better outcomes. This finding is consistent with previous studies reporting that a low LDL-C level was a negative predictor of survival in HF patients 49,50 and a recent population-based observational cohort study with 31619 IHD patients showing no decrease in cardiac events from lowering LDL-C level to <70 mg/dL compared with LDL-C of 70 to 100 mg/dL. 20 Although it is speculative, the lack of statin benefits in patients with low LDL-C levels could be explained, at least in part, by the poor outcomes of patients with cardiac cachexia accompanied by progressive involuntary weight loss and lower LDL-C. 51,52 Indeed, several studies have reported that lower BMI was significantly associated with poor prognosis in HF patients, whereas obese patients have rather better outcomes, known as the "obesity paradox."…”