高密度脂蛋白胆固醇水平与晚期心力衰竭的预后。

High-density lipoprotein cholesterol levels and prognosis in advanced heart failure.

机构信息

Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.

出版信息

J Heart Lung Transplant. 2009 Sep;28(9):876-80. doi: 10.1016/j.healun.2009.04.026.

DOI:10.1016/j.healun.2009.04.026

PMID:19716038

Abstract

BACKGROUND

High-density lipoproteins (HDLs) influence the generation of prostacyclin via cyclooxygenase stimulation. Prostaglandins represent an important compensatory pathway in advanced heart failure (HF). Whether HDL levels discriminate prognosis in HF remains unknown.

METHODS

We prospectively evaluated the prognostic relationship of HDL levels in severe HF by examining 132 consecutive patients listed for heart transplantation (52 +/- 11 years of age, 80% men, 79% white, mean follow-up 18 months). Using population mean HDL levels (HDL <33 mg/dl [n = 47] vs > or =33 mg/dl [n = 85]), patients were grouped and followed for the primary composite end-points of HF hospitalizations or death, stratified by underlying etiology (non-ischemic, n = 52; ischemic, n = 80).

RESULTS

Patients with HDL <33 mg/dl had lower serum sodium (135 vs 137 mEq/liter, p = 0.008), higher total bilirubin (1.3 vs 0.7 mg/dl, p < 0.001) and higher uric acid (7.6 vs 6.7 mg/dl, p = 0.048) levels, but similar serum creatinine compared with the > or =33 mg/dl HDL group. Survival analysis, using a Cox proportional hazards model, revealed reduced HDL (<33 mg/dl) as the most significant independent predictor of HF hospitalizations or death, independent of underlying etiology. Low-cholesterol and low-density lipoprotein (LDL)-cholesterol alone were not found to be independently predictive of outcome.

CONCLUSIONS

Lower HDL levels correlate with adverse prognosis independent of etiology and predict clinical worsening or death in advanced HF. Further study is warranted as to whether these findings represent a clinical marker or suggest a potential therapeutic target.

摘要

背景

高密度脂蛋白（HDL）通过刺激环氧化酶影响前列环素的产生。前列腺素是晚期心力衰竭（HF）的重要代偿途径。HDL 水平是否能区分 HF 的预后尚不清楚。

方法

我们前瞻性评估了严重 HF 中 HDL 水平的预后相关性，共纳入了 132 例连续接受心脏移植的患者（52±11 岁，80%为男性，79%为白人，平均随访 18 个月）。根据人群平均 HDL 水平（HDL<33mg/dl[n=47]与≥33mg/dl[n=85]），将患者分组并随访主要复合终点（HF 住院或死亡），按基础病因分层（非缺血性，n=52；缺血性，n=80）。

结果

HDL<33mg/dl 的患者血清钠水平较低（135 vs 137mEq/L，p=0.008），总胆红素水平较高（1.3 vs 0.7mg/dl，p<0.001）和尿酸水平较高（7.6 vs 6.7mg/dl，p=0.048），但血清肌酐水平与 HDL≥33mg/dl 组相似。采用 Cox 比例风险模型进行生存分析显示，HDL 降低（<33mg/dl）是 HF 住院或死亡的最显著独立预测因素，与基础病因无关。单独的低胆固醇和低密度脂蛋白（LDL）-胆固醇水平并未发现是独立的预后预测因素。