Abstract P359: Both High and Low Total Cholesterol Levels Are Associated With Poor Prognosis in Patients With Left Ventricular Systolic Dysfunction
AIM To assess the influence of total cholesterol level on prognosis in patients with left ventricular systolic dysfunction (LVSD). METHODS Patients presenting to a HF clinic (2000-2006) were screened. Those with LVSD were divided into 3 groups based on tertiles of total cholesterol level. All-cause mortality data was used for Kaplan-Meier curve and Cox regression analysis to assess the prognostic significance of total cholesterol level in these patients. RESULTS Of 2901 patients screened, 1342 had some degree of LVSD on echocardiogram, classified as mild (EF=41-50%; N = 478), moderate (EF=31-40%; N = 513), and severe (EF≤30%; N = 351). Median age was 72 (interquartile range 65-78) yrs, 71% (952 of 1342) were men. Mean follow-up was 37.6 months, during which 340 deaths occurred. Kaplan-Meier curves were generated for the 3 groups based on tertiles of serum cholesterol level (cut-off points 162 and 197 mg/dL) (Figure 1). Patients in the lower and upper tertiles had similar prognosis, which was significantly worse than the middle tertile (log rank=0.004). On multivariate analysis, age (p=0.001), ischemic etiology (p=0.003), NYHA class (p=0.001) and total cholesterol levels below 162 and above 197 mg/dL (p = 0.026) were independent predictors of poor prognosis in patients with LVSD. Though the 3 cholesterol groups were evenly matched for NYHA Class and severity of LVSD, NT pro-BNP levels were significantly higher in the lowest tertile group (p=0.005). CONCLUSION In patients with LVSD, both high and low cholesterol levels are associated with poor prognosis. Low cholesterol may be a marker of severity of disease and cardiac cachexia in patients with LVSD, accounting for their poor prognosis.