High-density lipoprotein cholesterol levels and prognosis in advanced heart failure.
BACKGROUND
High-density lipoproteins (HDLs) influence the generation of prostacyclin via cyclooxygenase stimulation. Prostaglandins represent an important compensatory pathway in advanced heart failure (HF). Whether HDL levels discriminate prognosis in HF remains unknown.


METHODS
We prospectively evaluated the prognostic relationship of HDL levels in severe HF by examining 132 consecutive patients listed for heart transplantation (52 +/- 11 years of age, 80% men, 79% white, mean follow-up 18 months). Using population mean HDL levels (HDL <33 mg/dl [n = 47] vs > or =33 mg/dl [n = 85]), patients were grouped and followed for the primary composite end-points of HF hospitalizations or death, stratified by underlying etiology (non-ischemic, n = 52; ischemic, n = 80).


RESULTS
Patients with HDL <33 mg/dl had lower serum sodium (135 vs 137 mEq/liter, p = 0.008), higher total bilirubin (1.3 vs 0.7 mg/dl, p < 0.001) and higher uric acid (7.6 vs 6.7 mg/dl, p = 0.048) levels, but similar serum creatinine compared with the > or =33 mg/dl HDL group. Survival analysis, using a Cox proportional hazards model, revealed reduced HDL (<33 mg/dl) as the most significant independent predictor of HF hospitalizations or death, independent of underlying etiology. Low-cholesterol and low-density lipoprotein (LDL)-cholesterol alone were not found to be independently predictive of outcome.


CONCLUSIONS
Lower HDL levels correlate with adverse prognosis independent of etiology and predict clinical worsening or death in advanced HF. Further study is warranted as to whether these findings represent a clinical marker or suggest a potential therapeutic target.
Mehra
Mandeep R
MR
Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. mmehra@medicine.umaryland.edu
Uber
Patricia A
PA
Lavie
Carl J
CJ
Milani
Richard V
RV
Park
Myung H
MH
Ventura
Hector O
HO
D000328:Adult; D001663:Bilirubin; D008076:Cholesterol, HDL / Q000097:blood*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000503:physiopathology / Q000601:surgery
D008076:Cholesterol, HDL; D001663:Bilirubin