title: Baseline low-density lipoprotein cholesterol levels and outcome in patients with heart failure.
abstract: The incidence of heart failure (HF) is constantly increasing in the Western world. Treatment with statins is well established for the primary and secondary prevention of cardiac events by lowering low-density lipoprotein (LDL) cholesterol levels. There are conflicting reports on the role of LDL cholesterol as an adverse prognostic predictor in patients with advanced HF. The aim of this study was to investigate the association between LDL cholesterol levels and clinical outcomes in 297 patients with severe HF (average New York Heart Association class 2.8). The mean follow-up period was 3.7 years (range 8 months to 11.5 years), and 37% of the patients died during follow-up. The mean time to first hospital admission for HF was 25 +/- 17 months. The study group was divided according to plasma LDL level < or =89, >89 to < or =115, >115 mg/dl. Patients with the highest baseline LDL cholesterol levels had significantly improved outcomes, whereas those with the lowest LDL cholesterol levels had the highest mortality. When analyzed with respect to statin use, it emerged that the negative association between LDL cholesterol level and mortality was present only in the patients with HF who were treated with statins. In conclusion, lower LDL cholesterol levels appear to predict less favorable outcomes in patients with HF, particularly those taking statins, raising questions about the need for aggressive LDL cholesterol-lowering strategy in patients with HF, regardless of its cause.
authors.affiliation: Department of Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. drcharach@012.net.il
authors.forename: Gideon
authors.initials: G
authors.lastname: Charach
authors.forename: Jacob
authors.initials: J
authors.lastname: George
authors.forename: Arie
authors.initials: A
authors.lastname: Roth
authors.forename: Ori
authors.initials: O
authors.lastname: Rogowski
authors.forename: Dov
authors.initials: D
authors.lastname: Wexler
authors.forename: David
authors.initials: D
authors.lastname: Sheps
authors.forename: Itamar
authors.initials: I
authors.lastname: Grosskopf
authors.forename: Moshe
authors.initials: M
authors.lastname: Weintraub
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.forename: Ardon
authors.initials: A
authors.lastname: Rubinstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death / Q000639:trends; D008078:Cholesterol, LDL / Q000097:blood* / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors