Low Serum Total Cholesterol and Triglycerides Are Associated with Adverse Events in Advanced Heart Failure: The “Lipid Paradox” in MEDAMACS

BackgroundIt has been suggested that low serum total cholesterol is associated with an increased risk of suicide.AimsTo study the association between serum total cholesterol, depression and suicide using versatile, prospective data.MethodA total of 29 133 men aged 50–69 years were followed up for 5–8 years. Baseline blood samples were analysed for serum total and high-density lipoprotein cholesterol concentrations. Self-reported depression was recorded, data on hospital treatments due to depressive disorders were derived from the National Hospital Discharge Register and deaths from suicide were identified from death certificates.ResultsLow serum total cholesterol was associated with low mood and subsequently a heightened risk of hospital treatment due to major depressive disorder and of death from suicide.ConclusionsOur results suggest that low serum total cholesterol appears to be associated with low mood and thus to predict its serious consequences.

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Low serum total cholesterol and mortality from accidents and suicide.

Lipids, health, and behavior. ◽

10.1037/10259-027 ◽

1997 ◽

pp. 263-273

Author(s):

Albertine J. Schuit ◽

Jacqueline M. Dekker ◽

Evert G. Schouten

Keyword(s):

Total Cholesterol ◽

Serum Total Cholesterol ◽

Low Serum

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HFrEF other treatment: ventricular assist devices

ESC CardioMed ◽

10.1093/med/9780198784906.003.0432 ◽

2018 ◽

pp. 1884-1889

Author(s):

Emer Joyce ◽

Randall C Starling

Keyword(s):

Heart Failure ◽

Adverse Events ◽

Continuous Flow ◽

Survival Rates ◽

Advanced Heart Failure ◽

Ventricular Assist Devices ◽

Ventricular Assist ◽

Assist Devices ◽

Heart Failure Patients ◽

Transplant Candidates

Over 30,000 ventricular assist devices (VADs) have been implanted worldwide in the past decade. Continuous-flow VAD therapy has realized greater durability and improved survival. Both axial and centrifugal flow devices are approved for the treatment of chronic and refractory advanced heart failure. Patients waiting for transplants that are ‘bridged’ and transplant-ineligible patients (destination therapy), receive VAD therapy. One-year survival rates are now approximately 80% and 70% at 2 years. The advent of continuous-flow VADs replaced volume displacement pulsatile VADs and numerous adverse events related to lack of circulatory pulsatility became recognized and prevalent as VAD therapy proliferated. Common adverse events include driveline infection, device infection, haemorrhagic and embolic stroke, bleeding, aortic insufficiency, and VAD thrombosis. Current VAD therapy requires systemic anticoagulation and antiplatelet therapy. A lack of donor hearts has resulted in prolonged and frequent VAD therapy in transplant candidates. Careful selection of VAD candidates is imperative and requires careful risk stratification. New VAD models with technological advances will enhance patient acceptance of VAD therapy and lead to further expansion in advanced heart failure patients.

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