Horwich Tamara B, Hernandez Adrian F, Dai David, Yancy Clyde W, Fonarow Gregg C
Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, CA 90095-1679, USA.
Am Heart J. 2008 Dec;156(6):1170-6. doi: 10.1016/j.ahj.2008.07.004. Epub 2008 Sep 9.
In chronic heart failure (HF), lower total cholesterol (TC) levels have been associated with increased mortality. However, the relationship between lipid levels and outcomes in acute HF has not been studied. This study investigates the relationship between cholesterol levels and in-hospital mortality in patients hospitalized with acute HF.
The Get With the Guidelines-Heart Failure registry prospectively collects data on patients hospitalized with HF. We analyzed data on 17,791 patients admitted between January 2005 and June 2007 at 236 participating hospitals who had TC levels recorded. Baseline patient characteristics, treatment regimens, and in-hospital mortality were examined by TC level (mg/dL) quartiles (Q) as follows: Q1 (TC < or =118), Q2 (TC 119-145), Q3 (TC 146-179), and Q4 (TC > or =180).
Mean TC level was 150 +/- 47 mg/dL. Patients with lower TC were older and had higher prevalence of ischemic heart disease. Of the patients, 46% were on a lipid-lowering drug, including 58%, 50%, 43%, and 34% of patients in TC Q1 to Q4, respectively. In-hospital mortality in TC Q1 to Q4 was 3.3%, 2.5%, 2.0%, and 1.3%, respectively (P < .0001). On multivariable adjusted analyses, each 10-mg/dL increase in TC level was associated with 4% decreased risk of in-hospital mortality (odds ratio 0.96, 95% CI 0.93-0.98).
In patients hospitalized with HF, lower TC levels independently predict increased in-hospital mortality risk. Further evaluation of optimal cholesterol levels and influence of lipid-lowering medication use on outcomes in this population is warranted.
在慢性心力衰竭（HF）中，总胆固醇（TC）水平较低与死亡率增加相关。然而，急性HF中血脂水平与预后的关系尚未得到研究。本研究调查了急性HF住院患者胆固醇水平与住院死亡率之间的关系。
“遵循心力衰竭指南”注册研究前瞻性收集HF住院患者的数据。我们分析了2005年1月至2007年6月期间在236家参与研究的医院住院且记录了TC水平的17791例患者的数据。根据TC水平（mg/dL）四分位数（Q）对患者的基线特征、治疗方案和住院死亡率进行如下检查：Q1（TC≤118）、Q2（TC 119 - 145）、Q3（TC 146 - 179）和Q4（TC≥180）。
平均TC水平为150±47 mg/dL。TC水平较低的患者年龄较大，缺血性心脏病患病率较高。在这些患者中，46%使用了降脂药物，其中TC Q1至Q4的患者分别为58%、50%、43%和34%。TC Q1至Q4的住院死亡率分别为3.3%、2.5%、2.0%和1.3%（P <.0001）。在多变量调整分析中，TC水平每升高10 mg/dL，住院死亡率风险降低4%（优势比0.96，95%可信区间0.93 - 0.98）。
在HF住院患者中，较低的TC水平独立预测住院死亡风险增加。有必要进一步评估该人群的最佳胆固醇水平以及降脂药物使用对预后的影响。
