Low serum total cholesterol is associated with marked increase in mortality in advanced heart failure

Background: Although hypercholesterolemia is a well-defined risk factor for morbidity and mortality in coronary artery disease, the relationship between cholesterol and heart failure (HF) has rarely been investigated. Methods: Cholesterol and lipoproteins were measured in 1,134 patients with advanced HF who presented to a single center for HF management and transplant evaluation. Patients were stratified into five groups based on quintiles of total cholesterol (TC) level, and differences in patient characteristics and survival were evaluated. Results: Patients with low TC had significantly lower low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides (TG), sodium, albumin, left ventricular ejection fraction, and cardiac output. The TC quintiles were similar in terms of HF etiology, hypertension, diabetes, and lipid-lowering therapy at time of referral. TC, LDL, HDL, and TG each predicted survival (P less than or equal to .01) on univariate analysis, with improved survival at higher levels. After adjustment for risk factors using a Cox proportional hazards model, relative risks were 2.071, 1.369, 1.391, 1.006 for the first, second, third, and fourth TC quintiles, with quintile 5 as reference. Conclusions: Serum TC represents a novel prognostic factor for patients with advanced HE Further studies are necessary to investigate a potential role of low cholesterol and lipoproteins in the pathophysiology of HF progression.