The Association Between Cholesterol and Mortality in Heart Failure Comparison Between Patients With and Without Coronary Artery Disease

Abstract

SUMMARYHypercholesterolemia is a risk factor for development of coronary artery disease (CAD), however, several reports have suggested that low serum cholesterol is associated with a worse prognosis in patients with congestive heart failure (CHF). The objective of this study was to determine the prognostic value of cholesterol for CHF. The study subjects consisted of 133 consecutive patients hospitalized in our institution for progressive heart failure from April 2000 to March 2003. Thirty-two percent of the patients had CAD. After improvement of congestive heart failure and discharge from the hospital, lipid profiles, including serum total cholesterol (TC), triglycerides, and high and low density lipoprotein cholesterol (HDL, LDL, respectively), were obtained. During the follow-up period (2.3 ± 0.9 years), 21 patients died. There was a significant difference between survivors and nonsurvivors in HDL (53 ± 15, 43 ± 15 mg/dL, P = 0.01), but no differences were observed in other variables. In patients with CAD, survivors had significantly lower TC concentrations (179 ± 30 versus 246 ± 55 mg/dL, P = 0.004), although in patients without CAD, survivors had significantly higher TC concentrations (203 ± 37 versus 170 ± 40 mg/ dL, P = 0.02). Multivariate analysis showed high TC predicted a worse outcome in patients with CAD (odds ratio (OR) = 1.052, 95% confidence interval (CI) 1.002-1.104, P = 0.04), but a better outcome in patients without CAD (OR = 0.972, 95% CI 0.948-0.997, P = 0.03), independent of age, gender, medication, and complications. Thus, low serum cholesterol is associated with an improved outcome in patients with CAD, while it predicts a worse outcome in patients without CAD. (Int Heart J 2005; 46: 619-629)

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

“…The relationship between LDL levels and HF outcomes among the elderly, which we document here, seems to be contradictory to the findings in patients with coronary artery disease [5,6,7,8,9] and in patients enrolled in other HF studies [8,9,11,18,19]. Several studies reported that patients with ischemic and nonischemic HF appear to have an opposite pattern (‘reverse epidemiology'), with low levels being associated with a worse prognosis independent of other prognostic factors [13,20].…”

“…Weight loss (not edematous) and cardiac cachexia are well-known independent risk factors for HF mortality. Unlike the results of other studies [9,14,19,21], our elderly patients with a range of LDL levels had the same normal albumin, creatinine, hemoglobin and body mass index values which are established markers of the nutritional state. They also had normal levels of the inflammatory marker, C-reactive protein.…”

“…Many large clinical and animal studies advocate the use of statins in chronic HF, assuming pleiotropic effects that are irrespective of cholesterol reduction [5,6,7,8,9]. There are, however, insufficient data to show whether or not low cholesterol levels influence outcome in HF patients [8,9,10]. …”

Assessment of the antidiabetic and antilipidemic properties of bacillus subtilis spb1 biosurfactant in alloxan‐induced diabetic rats

“…Under the last condition, the biosurfactant can block the active form of the protein, thus making the catalytic site accessible to the inhibitor . The elevation of serum lipids is usually associated with diabetes mellitus, which is the major risk factor of coronary heart diseases . The risk of the development of atherosclerosis in diabetes mellitus can be reduced by elevating HDL‐cholesterol level .…”

Association of total cholesterol and HDL-C levels and outcome in coronary heart disease patients with heart failure

“…[3,4] Theoretically, reducing TC and LDL-C levels would not only decrease the incidence of CHD as evidenced by previous clinical trials but may also improve HF patients’ outcomes. Nevertheless, 2 randomized controlled trials showed no mortality benefit of rosuvastatin therapy in HF patients, [5,6] despite substantial reduction of TC and LDL-C was achieved.…”