title: Gender differences in total cholesterol levels in patients with acute heart failure and its importance for short and long time prognosis.
abstract: OBJECTIVE
  The purpose of this study was to evaluate whether there are gender differences in total cholesterol levels in patients with acute heart failure and if there is an association of this parameter with short and long time mortality.
  
  
  METHODS
  The AHEAD MAIN registry is a database conducted in 7 university hospitals, all with 24 h cath lab service, in 4 cities in the Czech Republic. The database included 4 153 patients hospitalised for acute heart failure in the period 2006-2009. 2 384 patients had a complete record of their total cholesterol levels. 946 females and 1437 males were included in this analysis. According to the admission total cholesterol levels, patients were divided into 5 groups: < 4.50 mmol/l (group A), 4.50-4.99 mmol/l (group B), 5.0-5.49 mmol/l (group C), 5.50-5.99 mmol/l (group D) and > 6.0 mmol/l (group E). The median total cholesterol levels were 4.24 in males and 4.60 in females (P<0.001). There were differences in the distribution of total cholesterol levels between men and women: group A 57.6 vs 45.0%, group B 13.8 vs 16.3%, group C 9.8 vs 12.5%, group D 7.7 vs 11.4%, group E 11.1 vs 14.8% respectively (all P<0.001). The median age of men was 68.7 vs 77.3 years in women (P<0.001). In all total cholesterol categories women were older than men: group A 77.7 vs 69.5 years, group B 78.6 vs 69.1 years, group C 77.3 vs 68.8 years, group D 76.8 vs 64.2 years, group E 75.6 vs 64.4 years (all P<0.001). For the calculation of long term mortality, the cohort was divided into three groups: total cholesterol levels below 4.50 mmol/l, 4.50-5.49 mmol/l and above 5.50 mmol/l. The log rank test was used for the analysis.
  
  
  RESULTS
  There were no differences in hospital mortality between male and female in general (9.2 vs 10.8%, P<0.202), or in total cholesterol levels in subgroups. Total cholesterol levels were associated with in-hospital mortality (P<0.002). In the long-term follow up (78 months) patients with total cholesterol levels below 4.5 mmol/l had the worst prognosis (P<0.001). An independent influence of total cholesterol level on mortality and survival was confirmed in the multivariate model as well.
  
  
  CONCLUSIONS
  Women with acute heart failure had higher total cholesterol levels than men in all ages. There was a higher percentage of women with total cholesterol levels above 6 mmol/l and lower percentage in the group below 4.5 mmol/l than in men. In all, total cholesterol categories women were older than men. Total cholesterol levels are important for in- hospital mortality and long term survival of patients admitted for acute heart failure.
authors.affiliation: Internal Cardioangiology Department, University Hospital St. Ann and Faculty of Medicine, Masaryk University Brno, Czech Republic. lenka.spinarova@fnusa.cz
authors.forename: Lenka
authors.initials: L
authors.lastname: Spinarova
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.forename: Jiri
authors.initials: J
authors.lastname: Vitovec
authors.forename: Ales
authors.initials: A
authors.lastname: Linhart
authors.forename: Petr
authors.initials: P
authors.lastname: Widimsky
authors.forename: Marian
authors.initials: M
authors.lastname: Fedorco
authors.forename: Filip
authors.initials: F
authors.lastname: Malek
authors.forename: Cestmir
authors.initials: C
authors.lastname: Cihalik
authors.forename: Roman
authors.initials: R
authors.lastname: Miklik
authors.forename: Ladislav
authors.initials: L
authors.lastname: Dusek
authors.forename: Klaudia
authors.initials: K
authors.lastname: Zidova
authors.forename: Jiri
authors.initials: J
authors.lastname: Jarkovsky
authors.forename: Simona
authors.initials: S
authors.lastname: Littnerova
authors.forename: Jiri
authors.initials: J
authors.lastname: Parenica
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002784:Cholesterol / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012727:Sex Characteristics; D015996:Survival Rate
chemical_list: D002784:Cholesterol