title: Impaired High-Density Lipoprotein Anti-Oxidative Function Is Associated With Outcome in Patients With Chronic Heart Failure.
abstract: Oxidative stress is mechanistically linked to the pathogenesis of chronic heart failure (CHF). Antioxidative functions of high-density lipoprotein (HDL) particles have been found impaired in patients with ischemic cardiomyopathy; however, the impact of antioxidative HDL capacities on clinical outcome in CHF patients is unknown. We therefore investigated the predictive value of antioxidative HDL function on mortality in a representative cohort of patients with CHF.
  
  
  
  We prospectively enrolled 320 consecutive patients admitted to our outpatient department for heart failure and determined antioxidative HDL function using the HDL oxidative index (HOI). During a median follow-up time of 2.8 (IQR: 1.8-4.9) years, 88 (27.5%) patients reached the combined cardiovascular endpoint defined as the combination of death due to cardiovascular events and heart transplantation. An HOI ≥1 was significantly associated with survival free of cardiovascular events in Cox regression analysis with a hazard ratio (HR) of 2.28 (95% CI 1.48-3.51, P<0.001). This association remained significant after comprehensive multivariable adjustment for potential confounders with an adjusted HR of 1.83 (95% CI 1.1-2.92, P=0.012). Determination of HOI significantly enhanced risk prediction beyond that achievable with N-terminal pro-B-type natriuretic peptide indicated by improvements in net reclassification index (32.4%, P=0.009) and integrated discrimination improvement (1.4%, P=0.04).
  
  
  
  Impaired antioxidative HDL function represents a strong and independent predictor of mortality in patients with CHF. Implementation of HOI leads to a substantial improvement of risk prediction in patients with CHF.
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
authors.forename: Lore
authors.initials: L
authors.lastname: Schrutka
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
authors.forename: Klaus
authors.initials: K
authors.lastname: Distelmaier
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
authors.forename: Philipp
authors.initials: P
authors.lastname: Hohensinner
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sulzgruber
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lang
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.|Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.
authors.forename: Johann
authors.initials: J
authors.lastname: Wojta
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Hülsmann
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Niessner
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria lorenz.koller@meduniwien.ac.at.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Koller
mesh_terms: D000368:Aged; D000975:Antioxidants / Q000378:metabolism*; D001317:Austria / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000378:metabolism* / Q000401:mortality; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000502:physiology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D000975:Antioxidants; D015415:Biomarkers; D008075:Lipoproteins, HDL
keywords: heart failure; high‐density lipoprotein cholesterol; oxidative stress; prognosis