Clinical research: heart failure
The relationship between cholesterol and survival in patients with chronic heart failure

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Abstract

Objectives

We sought to describe the relationship between cholesterol and survival in patients with chronic heart failure (CHF).

Background

Increasing lipoprotein levels are a cardiovascular risk factor. In patients with CHF, the prognostic value of endogenous lipoproteins is not fully clarified.

Methods

A group of 114 patients with CHF recruited to a metabolic study was followed for a minimum of 12 months (derivation study). The results were applied to a second group of 303 unselected patients with CHF (validation study). The relationship between endogenous lipoproteins and survival was explored.

Results

In the derivation study, survival at 12 months was 78% (95% confidence interval [CI] 70% to 86%) and 56% (95% CI 51% to 62%) at 36 months. Increasing total serum cholesterol was a predictor of survival (hazard ratio 0.64, 95% CI 0.48 to 0.86), independent of the etiology of CHF, age, left ventricular ejection fraction, and exercise capacity. Receiver-operating characteristic curves demonstrated a best cut-off value of ≤5.2 mmol/l (200.8 mg/dl) as being the best predictor of mortality at 12 months (sensitivity 80.0%, specificity 62.9%). In the validation population, one-year survival was 88% (95% CI 84 to 91%) and three-year survival was 68% (95% CI 63 to 73%). The chance of survival increased 25% for each mmol/l increment in total cholesterol. Survival rates above and below the cut-off value for cholesterol in patients with ischemic heart disease (n = 181) were 92% (95% CI 89 to 94) versus 75% (95% CI 64 to 85%) at one year and 72% (95% CI 67 to 76%) versus 50% (95% CI 43 to 56%) at three years.

Conclusions

In patients with CHF, lower serum total cholesterol is independently associated with a worse prognosis.

Abbreviations

CHF
chronic heart failure
CI
confidence interval
HDL
high-density lipoprotein
HMG-CoA
3-hydroxy-3-methylglutaryl coenzyme A
HR
hazard ratio
LDL
low-density lipoprotein
LPS
lipopolysaccharide
LVEF
left ventricular ejection fraction
ROC
receiver-operating characteristics
sTNF-R1
soluble tumor necrosis factor receptor type 1
Vo2
oxygen consumption
Ve/Vco2slope
slope of the relationship between ventilation and carbon dioxide production

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