CLINICAL RESEARCH: HEART FAILURE
The relationship between cholesterol and survival in patients with chronic heart failure
Mathias Rauchhaus, MD* ,
Andrew L. Clark, MD ,*,
Wolfram Doehner, MD*,
Constantinos Davos, MD, PhD*,
Aidan Bolger, BSc*,
Rakesh Sharma, BSc*,
Andrew J. S. Coats, DM* and
Stefan D. Anker, MD, PhD*
* Clinical Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom
Klinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität, Halle, Germany
Academic Cardiology, Castle Hill Hospital, Hull, United Kingdom
Franz-Volhard-Klinik (Charité, Campus Berlin-Buch) am Max-Delbrück Centrum für Molekulare Medizin, Berlin, Germany
Manuscript received April 9, 2003;
revised manuscript received July 25, 2003,
accepted July 28, 2003.
* Reprint requests and correspondence: Dr. Andrew L. Clark, Academic Cardiology, Castle Hill Hospital, Castle Road, Cottingham, Kingston-upon-Hull HU16 5JQ, United Kingdom.
A.L.Clark{at}hull.ac.uk
OBJECTIVES: We sought to describe the relationship between cholesterol and survival in patients with chronic heart failure (CHF).
BACKGROUND: Increasing lipoprotein levels are a cardiovascular risk factor. In patients with CHF, the prognostic value of endogenous lipoproteins is not fully clarified.
METHODS: A group of 114 patients with CHF recruited to a metabolic study was followed for a minimum of 12 months (derivation study). The results were applied to a second group of 303 unselected patients with CHF (validation study). The relationship between endogenous lipoproteins and survival was explored.
RESULTS: In the derivation study, survival at 12 months was 78% (95% confidence interval [CI] 70% to 86%) and 56% (95% CI 51% to 62%) at 36 months. Increasing total serum cholesterol was a predictor of survival (hazard ratio 0.64, 95% CI 0.48 to 0.86), independent of the etiology of CHF, age, left ventricular ejection fraction, and exercise capacity. Receiver-operating characteristic curves demonstrated a best cut-off value of  5.2 mmol/l (200.8 mg/dl) as being the best predictor of mortality at 12 months (sensitivity 80.0%, specificity 62.9%). In the validation population, one-year survival was 88% (95% CI 84 to 91%) and three-year survival was 68% (95% CI 63 to 73%). The chance of survival increased 25% for each mmol/l increment in total cholesterol. Survival rates above and below the cut-off value for cholesterol in patients with ischemic heart disease (n = 181) were 92% (95% CI 89 to 94) versus 75% (95% CI 64 to 85%) at one year and 72% (95% CI 67 to 76%) versus 50% (95% CI 43 to 56%) at three years.
CONCLUSIONS: In patients with CHF, lower serum total cholesterol is independently associated with a worse prognosis.
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Abbreviations and Acronyms
| | CHF | = chronic heart failure | | CI | = confidence interval | | HDL | = high-density lipoprotein | | HMG-CoA | = 3-hydroxy-3-methylglutaryl coenzyme A | | HR | = hazard ratio | | LDL | = low-density lipoprotein | | LPS | = lipopolysaccharide | | LVEF | = left ventricular ejection fraction | | ROC | = receiver-operating characteristics | | sTNF-R1 | = soluble tumor necrosis factor receptor type 1 | | VO2 | = oxygen consumption | | VE/VCO2 slope | = slope of the relationship between ventilation and carbon dioxide production |
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