Differential effects of lipids on the risk of heart failure and coronary heart disease: the Physicians' Health Study.
BACKGROUND
It is understood that coronary heart disease (CHD) is one cause of heart failure, and many risk factors are common to both entities. Hypercholesterolemia, however, being a well-recognized risk factor for CHD, has an unclear association with incident heart failure.


METHODS
We evaluated the relations of total and high-density lipoprotein (HDL) cholesterol to incident heart failure and CHD in 10,813 US male physicians (mean age, 68 years). Total and HDL cholesterol were analyzed both as continuous and as categorical (in quartiles) variables.


RESULTS
There were 222 incident heart failure cases on follow-up (mean, 6 years). In Cox models, after adjusting for traditional coronary risk factors, 1-SD increase in total cholesterol (36.7 mg/dL) and HDL cholesterol (15.3 mg/dL) was not related to incident heart failure with a hazard ratio and 95% CI of 0.91 (0.79-1.05) for total cholesterol and 0.95 (0.82-1.11) for HDL cholesterol. In categorical models, heart failure risk in second, third, and fourth quartiles of total and HDL cholesterol was statistically not different from those in the lowest quartile; hazard ratios with 95% CI were 0.72 (0.49-1.05), 0.76 (0.52-1.11), 0.73 (0.50-1.09) for total cholesterol, and 0.78 (0.53-1.15), 0.66 (0.43-1.00), and 1.03 (0.69-1.54), for HDL cholesterol. Further adjustment for CHD on follow-up or exclusion of individuals with CHD at baseline did not alter the results. In contrast, high total cholesterol and low HDL cholesterol increased the risk of incident CHD (P < .001).


CONCLUSIONS
In healthy males, total and HDL cholesterol levels were not related to incident heart failure.
Dhingra
Ravi
R
Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA. ravidhingra27@hotmail.com
Sesso
Howard D
HD
Kenchaiah
Satish
S
Gaziano
J Michael
JM
D000368:Aged; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood*; D003327:Coronary Disease / Q000097:blood* / Q000209:etiology; D006306:Health Surveys; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications*; D015994:Incidence; D008297:Male; D012307:Risk Factors
D008076:Cholesterol, HDL; D002784:Cholesterol