title: The relationship between cholesterol and survival in patients with chronic heart failure.
abstract: OBJECTIVE
  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.
authors.affiliation: Clinical Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom.
authors.forename: Mathias
authors.initials: M
authors.lastname: Rauchhaus
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: Wolfram
authors.initials: W
authors.lastname: Doehner
authors.forename: Constantinos
authors.initials: C
authors.lastname: Davos
authors.forename: Aidan
authors.initials: A
authors.lastname: Bolger
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sharma
authors.forename: Andrew J S
authors.initials: AJ
authors.lastname: Coats
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
mesh_terms: D000367:Age Factors; D002784:Cholesterol / Q000097:blood*; D002908:Chronic Disease; D017079:Exercise Tolerance; D006333:Heart Failure / Q000097:blood / Q000401:mortality*; D006801:Humans; D008074:Lipoproteins / Q000097:blood; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D015996:Survival Rate
chemical_list: D008074:Lipoproteins; D002784:Cholesterol