title: Low serum total cholesterol level is a surrogate marker, but not a risk factor, for poor outcome in patients hospitalized with acute heart failure: a report from the Korean Heart Failure Registry.
abstract: BACKGROUND
  Hypercholesterolemia is a major risk factor for incident coronary artery disease and the prevalence of heart failure (HF). The causal relationship between low total cholesterol (TC) levels and poor clinical outcome in patients with acute HF has not been investigated. This study evaluated the effect of cholesterol levels on the long-term outcome in patients hospitalized due to acute HF.
  
  
  RESULTS
  We analyzed a cohort of 2,797 HF patients who were eligible for analysis in 3,200 patients of the Korean Heart Failure Registry. Patients were stratified into quartiles of TC (Q1 <133, Q2 133-158, Q3 159-190, and Q4 >190 mg/dL). Propensity score matching was performed with the patients in Q1 and Q4. Patients with lower serum TC had lower blood pressure, lower hemoglobin, lower serum sodium, and higher natriuretic peptide levels than patients with higher TC levels. Low TC was associated with increased risks for death and readmission due to HF; the adjusted hazard ratio (HR) of Q1 compared with Q4 was 1.57 (95% confidence interval [CI] 1.30-1.90). However, propensity score matching analysis revealed that low cholesterol itself did not affect outcome (HR 1.12, 95% CI 0.85-1.48).
  
  
  CONCLUSIONS
  Low TC is strongly associated with mortality and morbidity in patients with HF. However, low TC seemed to be a secondary result of the patient's state rather than an independent risk factor for poor outcome.
authors.affiliation: Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, South Korea.
authors.forename: Chang-Hwan
authors.initials: CH
authors.lastname: Yoon
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Youn
authors.forename: Soyeon
authors.initials: S
authors.lastname: Ahn
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Choi
authors.forename: Goo-Young
authors.initials: GY
authors.lastname: Cho
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Chae
authors.forename: Ji
authors.initials: J
authors.lastname: Choi
authors.forename: Hyungjun
authors.initials: H
authors.lastname: Cho
authors.forename: Seongwoo
authors.initials: S
authors.lastname: Han
authors.forename: Myeong-Chan
authors.initials: MC
authors.lastname: Cho
authors.forename: Eun-Seok
authors.initials: ES
authors.lastname: Jeon
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.forename: Jae-Joong
authors.initials: JJ
authors.lastname: Kim
authors.forename: Kyu-Hyung
authors.initials: KH
authors.lastname: Ryu
authors.forename: Byung-Hee
authors.initials: BH
authors.lastname: Oh
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002784:Cholesterol / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002784:Cholesterol