title: Prognostic significance of serum cholesterol levels in patients with idiopathic dilated cardiomyopathy.
abstract: OBJECTIVE
  Previous studies indicate that low cholesterol levels are associated with adverse prognosis in heart failure patients, because elevated lipoprotein levels may negate bacterial endotoxin load induced by gastrointestinal congestion.
  
  
  RESULTS
  We examined the prognostic significance of lipid levels in a cohort of 422 patients with idiopathic dilated cardiomyopathy (iDCM) [50+/-12 years, 342 males, 80 females, left ventricular ejection fraction (LV-EF): 31.6+/-10.6%]. During 42 months of follow-up, 86 patients (20.3%) died or received a heart transplant. In univariate Cox regression analysis, reduced LV-EF, high New York Heart Association (NYHA) class, and increased LV end-diastolic diameter (LVEDD) were strong risk factors associated with that endpoint, whereas decreased total cholesterol, HDL-cholesterol, and apoprotein I levels were identified as weak risk predictors. After step-wise multivariable analysis, only LVEDD, NYHA class, and LV-EF emerged as parameters independently contributing to the model predicting risk for death or heart transplantation (P<0.05). Cholesterol levels were positively associated with LV-EF and negatively associated with LVEDD (P<0.05). Circulating sCD14 levels, a marker of endotoxin exposure, were related to cholesterol levels (P<0.05) and LV-EF (P<0.05).
  
  
  CONCLUSIONS
  Decreased cholesterol levels do not independently predict adverse prognosis in patients with iDCM. Our findings indicate that low cholesterol levels are dependent on the severity of cardiac disease.
authors.affiliation: Klinik für Innere Medizin, Kardiologie und Intensivmedizin, Philipps University Marburg, Baldingerstrasse, D-35033 Marburg, Germany. christ_michael@yahoo.de
authors.forename: Michael
authors.initials: M
authors.lastname: Christ
authors.forename: Theresia
authors.initials: T
authors.lastname: Klima
authors.forename: Wolfram
authors.initials: W
authors.lastname: Grimm
authors.forename: Hans-Helge
authors.initials: HH
authors.lastname: Mueller
authors.forename: Bernhard
authors.initials: B
authors.lastname: Maisch
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000097:blood*; D002784:Cholesterol / Q000097:blood*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index
chemical_list: D002784:Cholesterol