Elevated cholesterol may benefit failing hearts

By Martha Kerr

NEW YORK (Reuters Health) - A moderately high total cholesterol level approaching 200 mg/dL is associated with higher survival in patients with heart failure than levels below 140 mg/dL, according to a report.

"Nonintuitive" is how principal investigator Heidi T. May of Latter Day Saints Hospital in Salt Lake City, Utah, describes the findings, since elevated total cholesterol, which is the sum of all the cholesterol present in a person's blood, is such a significant risk factor for heart disease.

Because inflammation is present in approximately 70 percent of patients with heart failure, and inflammation is associated with lower total cholesterol, May and colleagues hypothesized that lower total cholesterol is associated with poorer survival in heart failure.

The researchers evaluated total cholesterol (TC) levels and survival in 1,646 patients with heart failure selected from the Intermountain Collaborative Study Registry, a 10-year database spanning the years 1993-2003.

Total cholesterol levels were divided into quartiles, with quartile 1 having TC levels of 140 mg/dL and below, quartile 2 had TC levels of 141-167 mg/dL, quartile 3 had TC levels between 1168-200 mg/dL and those in the highest quartile had TC levels above 200 mg/dL.

The hazard ratio for death for those in quartile 3 compared with quartile 1 was 0.66, or a mortality risk reduction of 34 percent. Mortality risk for quartile 1 and quartile 4 was similar.

Patients in quartile 3 had the lowest CRP levels, indicating the lowest levels of inflammation of the four groups. The highest CRP levels occurred in patients in quartile 1.

However, "there is a point at which high cholesterol adversely affects survival," May told Reuters Health. Thus, she concluded, "the findings suggest that both cholesterol and inflammation need to be adequately treated in patients with heart failure."

SOURCE: American Journal of Cardiology September 2006.