title: Relationships between the serum cholesterol levels, production of monocyte proinflammatory cytokines and long-term prognosis in patients with chronic heart failure.
abstract: OBJECTIVE
  Low serum cholesterol is associated with a poor prognosis in patients with chronic heart failure (CHF). However, the relationships between the serum cholesterol level, production of monocyte proinflammatory cytokines and long-term prognosis in CHF patients remain unclear.
  
  
  METHODS
  A total of 95 CHF patients who had not been treated with statins and had a mean left ventricular ejection fraction of 26.0±6.0% were examined. Peripheral blood mononuclear cells (PBMCs) were isolated, and the production of monocyte tumor necrosis factor (TNF)-α and interleukin (IL)-6 was measured and expressed as the mean ± SD (pg/mL/10(6) PBMCs).
  
  
  RESULTS
  The production of monocyte TNF-α and IL-6 was found to be significantly and negatively associated with the serum low-density lipoprotein (LDL)-cholesterol level (TNF-α: r=-0.515, p<0.001, IL-6: r=-0.419, p<0.001). During a median follow-up of 66.0 months, 49 patients developed cardiac events, including 21 cardiac deaths and 28 readmissions for worsening CHF. A multivariate Cox hazard analysis showed that a monocyte TNF-α level of ≥4.9 pg/mL/10(6) PBMCs [hazard ratio (HR) 187.38, 95% confidence interval (CI) 7.92-4,434.94, p=0.001] and LDL-cholesterol level of <120 mg/dL (HR 9.41, 95% CI 1.02-86.66, p=0.048) were independently associated with the incidence of cardiac events.
  
  
  CONCLUSIONS
  Low LDL-cholesterol and the upregulation of monocyte proinflammatory cytokine production are both significantly and independently associated with poor outcomes in CHF patients.
authors.affiliation: Department of Internal Medicine and Cardiology, Tama-Nagayama Hospital, Nippon Medical School, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nakagomi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Seino
authors.forename: Satsuki
authors.initials: S
authors.lastname: Noma
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kohashi
authors.forename: Munenori
authors.initials: M
authors.lastname: Kosugi
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Kato
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Kusama
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Atarashi
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D007963:Leukocytes, Mononuclear / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002784:Cholesterol