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HDL subclasses and mortality in acute heart failure patients.

ABSTRACT: The link between HDL subclasses and the prognosis of cardiovascular diseases remains controversial. We thus evaluated the prognostic value of the HDL subclasses 3 and 2 cholesterol (HDL3-C, HDL2-C) as well as of total HDL-C for 3-month mortality in acute heart failure (AHF) patients. The serum levels of HDL3-C and total HDL-C were determined by detergent-based homogeneous assay. HDL2-C was computed by the difference between total HDL-C and HDL3-C. Out of the 132 analyzed patients, 35 (26.5%) died within three months after onset of AHF. Univariate logistic regression analyses revealed a significant inverse association of HDL3-C (odds ratio (OR) 0.46 per 1-SD increase, 95% confidence interval (CI) 0.27-0.72, p?= 0.001) with 3-month mortality, whereas concentrations of total HDL-C and HDL2-C showed no significant association. After adjustment for various laboratory and clinical parameters known to be associated with mortality in heart failure patients, HDL3-C concentrations remained significantly associated with 3-month mortality (OR 0.34 per 1-SD increase, 95% CI 0.15-0.74, p?=0.010). We conclude that low admission serum levels of HDL3-C are associated with an increased 3-month mortality in AHF patients, whereas total HDL-C and HDL2-C showed no association. HDL3-C might thus be useful as a prognostic parameter in AHF.

SUBMITTER: Degoricija V

PROVIDER: S-EPMC6591134 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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HDL subclasses and mortality in acute heart failure patients.

Degoricija Vesna V Potočnjak Ines I Gastrager Michaela M Pregartner Gudrun G Berghold Andrea A Scharnagl Hubert H Stojakovic Tatjana T Tiran Beate B Marsche Gunther G Frank Saša S

Clinica chimica acta; international journal of clinical chemistry 20181219

The link between HDL subclasses and the prognosis of cardiovascular diseases remains controversial. We thus evaluated the prognostic value of the HDL subclasses 3 and 2 cholesterol (HDL3-C, HDL2-C) as well as of total HDL-C for 3-month mortality in acute heart failure (AHF) patients. The serum levels of HDL3-C and total HDL-C were determined by detergent-based homogeneous assay. HDL2-C was computed by the difference between total HDL-C and HDL3-C. Out of the 132 analyzed patients, 35 (26.5%) die ...[more]

PMID: 30578754

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Project description:AIMS:Heart failure is a syndrome with increasing prevalence in concordance with the aging population and better survival rates from myocardial infarction. Morbidity and mortality are high in chronic heart failure patients, particularly in those with hospital admission for acute decompensation. Several risk stratification tools and score systems have been established to predict mortality in chronic heart failure patients. However, identification of patients at risk with easy obtainable clinical factors that can predict mortality in acute decompensated heart failure (ADHF) are needed to optimize the care-path. METHODS AND RESULTS:We retrospectively analyzed electronic medical records of 78 patients with HFrEF and HFmrEF who were hospitalized with ADHF in the Heart Center of the University Hospital Cologne in the year 2011 and discharged from the ward after successful treatment. 37.6?±?16.4 months after index hospitalization 30 (38.5%) patients had died. This mortality rate correlated well with the calculated predicted survival with the Seattle Heart Failure Model (SHFM) for each individual patient. In our cohort, we identified elevated heart rate at discharge as an independent predictor for mortality (p?=?0.016). The mean heart rate at discharge was lower in survived patients compared to patients who died (72.5?±?11.9 vs. 79.1?±?11.2 bpm. Heart rate of 77 bpm or higher was associated with an almost doubled mortality risk (p?=?0.015). Heart rate elevation of 5 bpm was associated with an increase of mortality of 25% (p?=?0.022). CONCLUSIONS:Patients hospitalized for ADHF seem to have a better prognosis, when heart rate at discharge is?<?77 bpm. Heart rate at discharge is an easily obtainable biomarker for risk prediction of mortality in HFrEF and HFmrEF patients treated for acute cardiac decompensation. Taking into account this parameter could be useful for guiding treatment strategies in these high-risk patients. Prospective data for validation of this biomarker and specific intervention are needed.

Project description:BACKGROUND:For acute myocardial infarction (AMI) without heart failure (HF), it is unclear if ?-blockers are associated with reduced mortality. OBJECTIVES:The goal of this study was to determine the association between ?-blocker use and mortality in patients with AMI without HF or left ventricular systolic dysfunction (LVSD). METHODS:This cohort study used national English and Welsh registry data from the Myocardial Ischaemia National Audit Project. A total of 179,810 survivors of hospitalization with AMI without HF or LVSD, between January 1, 2007, and June 30, 2013 (final follow-up: December 31, 2013), were assessed. Survival-time inverse probability weighting propensity scores and instrumental variable analyses were used to investigate the association between the use of ?-blockers and 1-year mortality. RESULTS:Of 91,895 patients with ST-segment elevation myocardial infarction and 87,915 patients with non-ST-segment elevation myocardial infarction, 88,542 (96.4%) and 81,933 (93.2%) received ?-blockers, respectively. For the entire cohort, with >163,772 person-years of observation, there were 9,373 deaths (5.2%). Unadjusted 1-year mortality was lower for patients who received ?-blockers compared with those who did not (4.9% vs. 11.2%; p < 0.001). However, after weighting and adjustment, there was no significant difference in mortality between those with and without ?-blocker use (average treatment effect [ATE] coefficient: 0.07; 95% confidence interval [CI]: -0.60 to 0.75; p = 0.827). Findings were similar for ST-segment elevation myocardial infarction (ATE coefficient: 0.30; 95% CI: -0.98 to 1.58; p = 0.637) and non-ST-segment elevation myocardial infarction (ATE coefficient: -0.07; 95% CI: -0.68 to 0.54; p = 0.819). CONCLUSIONS:Among survivors of hospitalization with AMI who did not have HF or LVSD as recorded in the hospital, the use of ?-blockers was not associated with a lower risk of death at any time point up to 1 year. (?-Blocker Use and Mortality in Hospital Survivors of Acute Myocardial Infarction Without Heart Failure; NCT02786654).

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HDL subclasses and mortality in acute heart failure patients.

Publications

HDL subclasses and mortality in acute heart failure patients.

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