Relation of Serum Total Cholesterol, C-reactive Protein Levels, and Statin Therapy to Survival in Heart Failure.
From: LDS Hospital, Salt Lake City, Utah, USA.
The American journal of cardiology
- Publish Date: Sep 2006
- ISSN: 0002-9149
- Volume: 98
- Issue: 5
- Pages: 653-8
- Medium: Print
- Language: English
- Citation (JAMA): May Heidi T, Muhlestein Joseph B, Carlquist John F, et al. Relation of Serum Total Cholesterol, C-reactive Protein Levels, and Statin Therapy to Survival in Heart Failure.. Am. J. Cardiol. Sep 2006;98:653-8
Abstract
Although increased cholesterol levels predict mortality in patients with coronary artery disease, it is unclear whether hypercholesterolemia is associated with adverse survival in patients with heart failure. A cohort of subjects derived from the Intermountain Heart Collaborative Study Registry (1993 to 2003) who had ejection fractions < or = 40% or clinical diagnoses of heart failure and long-term follow-up for death were studied (n = 1,646). Total cholesterol (TC) was divided into quartiles: quartile 1, < 141.3 mg/dl; quartile 2, 141.3 to 167.9 mg/dl; quartile 3, 168.0 to 201.0 mg/dl; and quartile 4, > 201.0 mg/dl. Multivariate Cox regression models were used to evaluate the associations of cholesterol, statin therapy, and C-reactive protein to mortality. The mean age was 65.5 years; 65% of the subjects were men and 65% had coronary artery disease. Although 53% were using statins, statin use was not different across TC quartiles. Average time to death was 2.4 years (maximum 10). Mortality for quartile 4 versus quartile 1 was not different (hazard ratio [HR] 1.12, p = 0.52); mortality was reduced for quartile 3 versus quartile 1 (HR 0.66, p = 0.027) and tended to be reduced for quartile 2 versus quartile 1 (HR 0.77, p = 0.14). Subanalysis of patients not using statins (n = 737, death = 20.2%) found no association between TC and survival (for quartile 3 vs quartile 1, HR 0.97, p = 0.89), but for patients using statins (n = 848, death = 16.3%), the effect was even greater for quartile 3 versus quartile 1 (HR 0.40, p = 0.002) than in the overall population. Nonsurvivors had higher levels of C-reactive protein than survivors. In conclusion, elevated TC appears to be associated with improved survival. The effect was stronger in patients receiving statin therapy, but the cause of this differential effect is uncertain.
Mesh Headings (Keywords): Aged, Biological Markers, C-Reactive Protein, Cholesterol, Female, Follow-Up Studies, Heart Failure, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Male, Middle Aged, Retrospective Studies, Risk Factors, Survival Rate, Time Factors, Treatment Outcome
Check for Full Text / PubMed Unique Identifier (PMID): 16923455
This abstract is part of PubMed, a service of the U.S. National Library of Medicine. PubMed includes more than 17 million citations from MEDLINE and other life science journals for biomedical articles. See Copyright and Disclaimers.
Linked medical terms appearing on this page are added by Healia to help readers find more information and are not part of the original PubMed document.
The data herein was last updated on July 8th, 2008 and may not reflect the most current and accurate data available from NLM.