High density lipoprotein cholesterol level predicts long-term clinical outcomes in patients with heart failure receiving cardiac resynchronization therapy

Abstract

Objective To assess the role of serum high density lipoprotein cholesterol(HDL-C)level on long-term clinical outcomes in patients receiving cardiac resynchronization therapy(CRT). Methods A total of 357 consecutive single-center patients with CRT between January 2010 and December 2015 were retrospectively enrolled and categorized into 2 groups based on serum HDL-C level(HDL-C≥1.0 mmol/L, HDL-C<1.0 mmol/L). During the follow-up, re-hospitalization due to worsening heart failure(HF)or all-cause mortality(including heart transplantation)was analyzed using Kaplan-Meier curves and log-rank test.Serum HDL-C level was evaluated in Cox proportional-hazards regression models as an independent prognostic factor. Results There were 168(47.1%)patients with lower HDL-C which had lower cholesterol, estimated glomerular filtration rate(eGFR)and proportion prescribed with spironolactone, and had higher body mass index, higher proportion of hypertension, diabetes, fasting blood glucose, alanine aminotransferase, serum creatinine, serum uric acid, high-sensitivity C reactive protein and proportion prescribed with digitalis.During the follow-up, 46(12.9%)patients died, 6(1.7%)underwent heart transplantation and 103(28.9%)had at least one HF readmission. Log-rank test analyses demonstrated that lower HDL-C was associated with a significantly higher HF re-hospitalization (χ2=7.822, P=0.005)and all-cause mortality(χ2=16.817, P=0.000). Cox analysis showed that lower HDL-C was the independent risk factor for HF re-hospitalization[hazard ratio(HR)=0.407, 95% confidence interval(CI): 0.178-0.933, P=0.096] and all-cause mortality(HR=0.256, 95%CI: 0.076-0.865, P=0.028). Conclusion In CRT patients, baseline serum HDL-C level is associated with clinical condition.HDL-C level is the independent risk factor for HF re-hospitalization and all-cause mortality. Key words: Cardiac resynchronization therapy; High density lipoprotein cholesterol; Heart failure; All-cause mortality