open access

Vol 66, No 5 (2008)
Other
Published online: 2008-05-26
Submitted: 2012-12-28
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Original article
Significance of dyslipidaemia in patients with heart failure of unexplained aetiology

Mirosław Skwarek, Zofia T. Bilińska, Łukasz Mazurkiewicz, Jacek Grzybowski, Mariusz Kruk, Paweł Kurjata, Walerian Piotrowski, Witold Rużyłło
Kardiol Pol 2008;66(5):515-522.

open access

Vol 66, No 5 (2008)
Other
Published online: 2008-05-26
Submitted: 2012-12-28

Abstract


Background: Dyslipidaemia has been studied in the prognosis of heart failure (HF). Little is known about the role of dyslipidaemia in the aetiopathogenesis of dilated cardiomyopathy (DCM).
Aim: To assess (1) serum lipid levels in DCM considering the severity of heart failure; (2) the association between DCM and lipid abnormalities; (3) prognostic significance of lipids in DCM.
Methods: The study group consisted of 100 patients with angiographically proven DCM [mean age 42 years, 80% males, 65% in NYHA class III-IV, mean left ventricular ejection fraction (LVEF) 32%], whose fasting serum lipids had been assessed during diagnosis between 1992 and 2001. Patients’ lipid levels were compared with those observed in healthy controls (n=100), age-, gender-, and BMI-matched and related to findings reported in population samples from WHO Pol-MONICA studies from: 1993 (n=526), 1997/1998 (n=526) and 2001 (n=1364). Three (3%) patients received lipid-lowering drugs. Transplant-free survival was assessed in the study group. In the statistical analysis, nonparametric Wilcoxon test and uni- and multivariate logistic and Cox regression analyses were used.
Results: Serum total cholesterol (TC), LDL (LDL-C) and HDL cholesterol (HDL-C) tended to be lower (differences NS) in NYHA class III-IV patients vs. class I-II (TC: 196.9&#177;45.5 vs. 207.9&#177;47.1 mg/dl, LDL-C 126.2&#177;37.5 vs. 128.5&#177;42.7 mg/dl, HDL-C 44.2&#177;11.3 vs. 44.7&#177; &#177;13.7 mg/dl, respectively), and triglycerides (TG) were lower in advanced HF vs. NYHA class I-II (135.9&#177;51 vs. 170.3&#177;63.4 mg/dl, p=0.004). In DCM patients HDL-C was lower than in controls (44.1&#177;12.1 vs. 54.3&#177;17.6 mg/dl, p <0.001), and TG level was higher (147.9&#177;58.1 vs. 114.1&#177;61.6 mg/dl, p <0.001). HDL-C and TG levels in controls were similar to those observed in population samples. Multivariate analysis with age, low HDL (defined as <40 mg/dl for males, and <50 mg/dl for females), and hyperTG (TG ł150 mg/dl) showed that both low HDL-C (OR=2.31; 95% CI 1.2-4.457, p=0.0122), and hyperTG (OR=1.978, 95% CI 1.029-3.799, p=0.0407) were independently associated with DCM. Low HDL-C level occurred more frequently in female DCM patients vs. in males (65 vs. 33.8%, p=0.022). There was a trend towards more frequent occurrence of hyperTG in male patients vs. females (42.5 vs. 20%, p=0.11). The mean follow-up time was 7.32&#177;4.7 years. In Cox univariate analysis low TC tended to be a prognostic factor (p=0.067), but in Cox multivariate analysis only NYHA class (HR=1.7, 95% CI 1.136-2.541; p=0.01) and LVEF (HR=0.963, 95% CI 0.932-0.996; p=0.027) turned out to be independent predictors of poor outcome.
Conclusion: Dyslipidaemia might play a role in the aetiopathogenesis of DCM. Low TC is not an independent prognostic factor in DCM.

Abstract


Background: Dyslipidaemia has been studied in the prognosis of heart failure (HF). Little is known about the role of dyslipidaemia in the aetiopathogenesis of dilated cardiomyopathy (DCM).
Aim: To assess (1) serum lipid levels in DCM considering the severity of heart failure; (2) the association between DCM and lipid abnormalities; (3) prognostic significance of lipids in DCM.
Methods: The study group consisted of 100 patients with angiographically proven DCM [mean age 42 years, 80% males, 65% in NYHA class III-IV, mean left ventricular ejection fraction (LVEF) 32%], whose fasting serum lipids had been assessed during diagnosis between 1992 and 2001. Patients&#8217; lipid levels were compared with those observed in healthy controls (n=100), age-, gender-, and BMI-matched and related to findings reported in population samples from WHO Pol-MONICA studies from: 1993 (n=526), 1997/1998 (n=526) and 2001 (n=1364). Three (3%) patients received lipid-lowering drugs. Transplant-free survival was assessed in the study group. In the statistical analysis, nonparametric Wilcoxon test and uni- and multivariate logistic and Cox regression analyses were used.
Results: Serum total cholesterol (TC), LDL (LDL-C) and HDL cholesterol (HDL-C) tended to be lower (differences NS) in NYHA class III-IV patients vs. class I-II (TC: 196.9&#177;45.5 vs. 207.9&#177;47.1 mg/dl, LDL-C 126.2&#177;37.5 vs. 128.5&#177;42.7 mg/dl, HDL-C 44.2&#177;11.3 vs. 44.7&#177; &#177;13.7 mg/dl, respectively), and triglycerides (TG) were lower in advanced HF vs. NYHA class I-II (135.9&#177;51 vs. 170.3&#177;63.4 mg/dl, p=0.004). In DCM patients HDL-C was lower than in controls (44.1&#177;12.1 vs. 54.3&#177;17.6 mg/dl, p <0.001), and TG level was higher (147.9&#177;58.1 vs. 114.1&#177;61.6 mg/dl, p <0.001). HDL-C and TG levels in controls were similar to those observed in population samples. Multivariate analysis with age, low HDL (defined as <40 mg/dl for males, and <50 mg/dl for females), and hyperTG (TG ł150 mg/dl) showed that both low HDL-C (OR=2.31; 95% CI 1.2-4.457, p=0.0122), and hyperTG (OR=1.978, 95% CI 1.029-3.799, p=0.0407) were independently associated with DCM. Low HDL-C level occurred more frequently in female DCM patients vs. in males (65 vs. 33.8%, p=0.022). There was a trend towards more frequent occurrence of hyperTG in male patients vs. females (42.5 vs. 20%, p=0.11). The mean follow-up time was 7.32&#177;4.7 years. In Cox univariate analysis low TC tended to be a prognostic factor (p=0.067), but in Cox multivariate analysis only NYHA class (HR=1.7, 95% CI 1.136-2.541; p=0.01) and LVEF (HR=0.963, 95% CI 0.932-0.996; p=0.027) turned out to be independent predictors of poor outcome.
Conclusion: Dyslipidaemia might play a role in the aetiopathogenesis of DCM. Low TC is not an independent prognostic factor in DCM.
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Keywords

heart failure; dilated cardiomyopathy; aetiopathogenesis; prognosis; dyslipidaemia; lipids

About this article
Title

Original article
Significance of dyslipidaemia in patients with heart failure of unexplained aetiology

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 66, No 5 (2008)

Pages

515-522

Published online

2008-05-26

Bibliographic record

Kardiol Pol 2008;66(5):515-522.

Keywords

heart failure
dilated cardiomyopathy
aetiopathogenesis
prognosis
dyslipidaemia
lipids

Authors

Mirosław Skwarek
Zofia T. Bilińska
Łukasz Mazurkiewicz
Jacek Grzybowski
Mariusz Kruk
Paweł Kurjata
Walerian Piotrowski
Witold Rużyłło

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