Statins attenuate but do not eliminate the reverse epidemiology of total serum cholesterol in patients with non-ischemic chronic heart failure.
BACKGROUND
In patients with chronic heart failure (CHF) increasing levels of total serum cholesterol are associated with improved survival - while statin usage is not. The impact of statin treatment on the "reverse epidemiology" of cholesterol is unclear.


METHODS
2992 consecutive patients with non-ischemic CHF due to left ventricular systolic dysfunction from the Norwegian CHF Registry and the CHF Registries of the Universities of Hull, UK, and Heidelberg, Germany, were studied. 1736 patients were individually double-matched on both cholesterol levels and the individual propensity scores for statin treatment. All-cause mortality was analyzed as a function of baseline cholesterol and statin use in both the general and the matched sample.


RESULTS
1209 patients (40.4%) received a statin. During a follow-up of 13,740 patient-years, 360 statin users (29.8%) and 573 (32.1%) statin non-users died. When grouped according to total cholesterol levels as low (≤3.6mmol/L), moderate (3.7-4.9mmol/L), high (4.8-6.2mmol/L), and very high (>6.2mmol/L), we found improved survival with very high as compared with low cholesterol levels. This association was present in statin users and non-users in both the general and matched sample (p<0.05 for each group comparison). The negative association of total cholesterol and mortality persisted when cholesterol was treated as a continuous variable (HR 0.83, 95%CI 0.77-0.90, p<0.001 for matched patients), but it was less pronounced in statin users than in non-users (F-test p<0.001).


CONCLUSIONS
Statins attenuate but do not eliminate the reverse epidemiological association between increasing total serum cholesterol and improved survival in patients with non-ischemic CHF.
University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany.
Hanna
H
Fröhlich
University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany.
Nandita
N
Raman
University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany.
Tobias
T
Täger
University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany.
Dieter
D
Schellberg
Castle Hill Hospital, Hull York Medical School in the University of Hull, Cottingham HU165JQ, United Kingdom.
Kevin M
KM
Goode
Castle Hill Hospital, Hull York Medical School in the University of Hull, Cottingham HU165JQ, United Kingdom.
Syed
S
Kazmi
Medical Department, Innlandet Hospital Trust Division Lillehammer, Anders Sandvigs gate 17, 2609 Lillehammer, Norway.
Morten
M
Grundtvig
Medical Faculty, Norwegian University of Science and Technology (NTNU), Trondheim, Norway & Medical Clinic, Helse Møre and Romsdal CHF, Åsehaugen 1, 6017 Ålesund, Norway.
Torstein
T
Hole
National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, SW72AZ London, United Kingdom.
John G F
JGF
Cleland
University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany.
Hugo A
HA
Katus
Department of Cardiology, Oslo University Hospital, Ulleval and Institute of Clinical Sciences, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.
Stefan
S
Agewall
Castle Hill Hospital, Hull York Medical School in the University of Hull, Cottingham HU165JQ, United Kingdom.
Andrew L
AL
Clark
Department of Cardiology, Oslo University Hospital, Ulleval and Institute of Clinical Sciences, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.
Dan
D
Atar
University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany. Electronic address: lutz.frankenstein@med.uni-heidelberg.de.
Lutz
L
Frankenstein
D000368:Aged; D000369:Aged, 80 and over; D002784:Cholesterol / Q000097:blood*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate / Q000639:trends
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol
Chronic heart failure; Prognosis; Reverse epidemiology; Serum cholesterol; Statins