Abstract 342: Prognostic Implications of Low Cholesterol and Statin Therapy in Heart Failure - the “Cholesterol Paradox”
Background: Heart failure is a common medical problem with poor prognosis. Treatment with statins is believed to be beneficial, but low cholesterol levels may be associated with adverse outcome.
Aim: To examine this “cholesterol paradox” in patients hospitalised with acute heart failure.
Methods: The EuroHeart Failure survey collected data from 10,701 patients with suspected heart failure in 115 hospitals from 24 countries across Europe during 2000 –2001. Investigations included a 12 lead ECG, echocardiogram and routine blood tests. The relation between cholesterol, lipid lowering drugs and mortality within 12 weeks of admission was examined by non parametric tests and logistic regression.
Results: A total of 1425 (12.5%) patients died between admission and 12 weeks follow up. A cholesterol level of > 5 mmol/l (193 mg/dl) and treatment with lipid lowering therapy were both independently associated with a better prognosis, odds ratios for death within 12 weeks being 0.6 (95% CI: 0.5 – 0.7) and 0.3 (95% CI: 0.3 –0.4) respectively. There was a linear relation between cholesterol levels and mortality, with those in the lower quintiles having the highest risk of death (p < 0.001) (see table⇓). In patients on lipid lowering therapy, the mortality was higher in patients with cholesterol levels at the two extremes (lowest and highest quintiles had a mortality of 23% and 30% respectively).
Conclusions: Low cholesterol levels were associated with worse prognosis in patients with acute heart failure. Statin therapy appears to be beneficial in acute heart failure, but this is probably due to other mechanisms (anti inflammatory, anti arrhythmic etc.), rather than cholesterol lowering effect.