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.
Highlights
Heart failure (HF) is a frequent cause of morbidity and mortality worldwide [1]
Clinical studies have shown that assessing circulating concentrations of HDL particles (HDL-P) by NMR spectroscopy is superior to HDL-cholesterol in predicting cardiovascular risk [16]
We have shown in our previous study that low serum concentrations of small but not large HDL-P, quantified by NMR spectroscopy, are associated with increased 3-month mortality in Acute heart failure (AHF) patients [17]
Summary
Being a final stage of various cardiovascular diseases, HF is defined by the European Society of Cardiology (ESC) as an abnormality of the cardiac structure and function, resulting in a diminished ability of the heart to maintain optimal perfusion of metabolizing tissues [2,3]. Quantity of the total HDL-C is dominated by the contribution of the larger, cholesterol-rich HDL2. This results in an inadequately low contribution of the smaller, denser, cholesterol-poor HDL3, whose cardioprotective activities are superior to that of HDL2 [10,11]. Clinical studies have shown that assessing circulating concentrations of HDL particles (HDL-P) by NMR spectroscopy is superior to HDL-cholesterol in predicting cardiovascular risk [16]
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