Metrics of High-Density Lipoprotein Function and Hospital Mortality in Acute Heart Failure Patients.
OBJECTIVE
The functionality of high-density lipoprotein (HDL) is impaired in chronic ischaemic heart failure (HF). However, the relationship between HDL functionality and outcomes in acute HF (AHF) has not been studied. The present study investigates whether the metrics of HDL functionality, including HDL cholesterol efflux capacity and HDL-associated paraoxonase (PON)-1 arylesterase (AE) activity are associated with hospital mortality in AHF patients.


RESULTS
The study was performed as a prospective, single-centre, observational research on 152 patients, defined and categorised according to the ESC and ACCF/AHA Guidelines for HF by time of onset, final clinical presentation and ejection fraction. The mean age of the included patients (52% female) was 75.2 years (SD 10.3) and hospital mortality was 14.5%. HDL cholesterol efflux capacity was examined by measuring the capacity of apoB depleted serum to remove tritium-labelled cholesterol from cultured macrophages. The AE activity of the HDL fraction was examined by a photometric assay. In a univariable regression analysis, low cholesterol efflux, but not AE activity, was significantly associated with hospital mortality [odds ratio (OR) 0.78, 95% confidence interval (CI) 0.64-0.96, p = 0.019]. In multivariable analysis progressively adjusting for important clinical and laboratory parameters the association obtained for cholesterol efflux capacity and hospital mortality by univariable analysis, despite a stable OR, did not stay significant (p = 0.179).


CONCLUSIONS
Our results suggest that HDL cholesterol efflux capacity (but not AE activity) contributes to, but is not an independent risk factor for, hospital mortality in AHF patients. Larger studies are needed to draw firm conclusions.
University Hospital Centre Sisters of Charity, Department of Medicine, Zagreb, Croatia.
Ines
I
Potočnjak
University Hospital Centre Sisters of Charity, Department of Medicine, Zagreb, Croatia.|University of Zagreb School of Medicine, Zagreb, Croatia.
Vesna
V
Degoricija
University Hospital Centre Sisters of Charity, Department of Medicine, Zagreb, Croatia.|University of Zagreb School of Medicine, Zagreb, Croatia.
Matias
M
Trbušić
University Hospital Centre Sisters of Charity, Department of Medicine, Zagreb, Croatia.
Sanda Dokoza
SD
Terešak
University Hospital Centre Zagreb, Zagreb, Croatia.
Bojana
B
Radulović
Institute for Medical Informatics, Statistics und Documentation, Medical University of Graz, Graz, Austria.
Gudrun
G
Pregartner
Institute for Medical Informatics, Statistics und Documentation, Medical University of Graz, Graz, Austria.
Andrea
A
Berghold
Clinical Institute for Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
Beate
B
Tiran
Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria.
Gunther
G
Marsche
Institute of Molecular Biology and Biochemistry, Centre of Molecular Medicine, Medical University Graz, Graz, Austria.
Saša
S
Frank
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002265:Carboxylic Ester Hydrolases / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies
D008076:Cholesterol, HDL; D008075:Lipoproteins, HDL; D002265:Carboxylic Ester Hydrolases; C019734:arylesterase