PurposeWhereas the cachexia of chronic heart failure (CHF) has often implicated muscle wasting, dysregulation of lipid metabolism is emerging as another facet of this syndrome. We hypothesized that advanced heart failure patients with low serum cholesterol and triglycerides resulting from chronically activated lipolysis would be at increased risk.Methods and MaterialsThe MEDAMACS Screening Pilot (n=168) enrolled patients with CHF on optimal therapy, LVEF<30%, and 2 hospitalizations in the past year or 1 hospitalization and 1 high risk feature. We stratified patients into four groups based on median serum total cholesterol (TC Median=128 mg/dL) and median triglycerides (TG Median=98 mg/dL) and performed Kaplan-Meier and Cox Models with an endpoint of survival free of inotrope dependence, mechanical circulatory support (MCS),or heart transplantation.ResultsThe presence of both serum TC and TG below median (35%) was associated with elevated right atrial pressure, decreased cardiac index, decreased albumin, and increased total bilirubin, but not a decreased BMI. Over a mean follow-up of 154 days, 64 events were recorded including home inotropic support, MCS, cardiac transplantation, and mortality. The group of patients with low serum TC and TG demonstrated the highest risk of events in univariate analysis and after multivariate adjustment (OR 3.3; 95% CI 1.5, 7.4; p=0.002). Decreased BMI was not associated with increased risk. [figure 1]ConclusionsThe presence of low serum TC and TG is associated with disease progression and increased risk in advanced heart failure. Future studies will investigate the reversibility of lipid dysregulation with therapies such as MCS. Whereas the cachexia of chronic heart failure (CHF) has often implicated muscle wasting, dysregulation of lipid metabolism is emerging as another facet of this syndrome. We hypothesized that advanced heart failure patients with low serum cholesterol and triglycerides resulting from chronically activated lipolysis would be at increased risk. The MEDAMACS Screening Pilot (n=168) enrolled patients with CHF on optimal therapy, LVEF<30%, and 2 hospitalizations in the past year or 1 hospitalization and 1 high risk feature. We stratified patients into four groups based on median serum total cholesterol (TC Median=128 mg/dL) and median triglycerides (TG Median=98 mg/dL) and performed Kaplan-Meier and Cox Models with an endpoint of survival free of inotrope dependence, mechanical circulatory support (MCS),or heart transplantation. The presence of both serum TC and TG below median (35%) was associated with elevated right atrial pressure, decreased cardiac index, decreased albumin, and increased total bilirubin, but not a decreased BMI. Over a mean follow-up of 154 days, 64 events were recorded including home inotropic support, MCS, cardiac transplantation, and mortality. The group of patients with low serum TC and TG demonstrated the highest risk of events in univariate analysis and after multivariate adjustment (OR 3.3; 95% CI 1.5, 7.4; p=0.002). Decreased BMI was not associated with increased risk. [figure 1] The presence of low serum TC and TG is associated with disease progression and increased risk in advanced heart failure. Future studies will investigate the reversibility of lipid dysregulation with therapies such as MCS.