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QJM. 2018 May 1;111(5):319-325. doi: 10.1093/qjmed/hcy043.

A longitudinal 20 years of follow up showed a decrease in the survival of heart failure patients who maintained low LDL cholesterol levels.

Author information

1
From the Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel.

Abstract

Background:

Treatment by statins is well established for primary and secondary prevention of cardiac events but may be hazardous for patients with heart failure (HF).

Aim:

We studied the long-term (20 years) association between baseline low-density lipoprotein cholesterol (LDL-c) levels and clinical outcome in patients with severe HF.

Design:

Patients were divided into those with plasma LDL-c levels 110 mg/dl (Group 1) or >110 mg/dl (Group 2).

Methods:

The mean follow-up of 305 study patients with advanced HF who had an average NYHA score of 2.7 was 11.3 years (range 15 months to 20 years). Mortality during follow-up was 43%.

Results:

Patients with the highest baseline LDL-c levels had significantly improved outcome, whereas those with the lowest LDL-c levels had the highest mortality. This paradoxical effect was prominent in patients <70 years old. The negative association of LDL-c levels and mortality was most conspicuous among the HF patients who were treated with statins.

Discussion and Conclusion:

Long-term follow-up findings showed that low LDL-c levels may predict a less favorable outcome in advanced HF, particularly in patients <70 years old and those taking statins. This negates the protocol of following an aggressive LDL-c-lowering strategy in younger patients with HF.

PMID:
29733423
DOI:
10.1093/qjmed/hcy043
[Indexed for MEDLINE]

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