The relationship between cholesterol and survival in patients with chronic heart failure

J Am Coll Cardiol. 2003 Dec 3;42(11):1933-40. doi: 10.1016/j.jacc.2003.07.016.


Objectives: We sought to describe the relationship between cholesterol and survival in patients with chronic heart failure (CHF).

Background: Increasing lipoprotein levels are a cardiovascular risk factor. In patients with CHF, the prognostic value of endogenous lipoproteins is not fully clarified.

Methods: A group of 114 patients with CHF recruited to a metabolic study was followed for a minimum of 12 months (derivation study). The results were applied to a second group of 303 unselected patients with CHF (validation study). The relationship between endogenous lipoproteins and survival was explored.

Results: In the derivation study, survival at 12 months was 78% (95% confidence interval [CI] 70% to 86%) and 56% (95% CI 51% to 62%) at 36 months. Increasing total serum cholesterol was a predictor of survival (hazard ratio 0.64, 95% CI 0.48 to 0.86), independent of the etiology of CHF, age, left ventricular ejection fraction, and exercise capacity. Receiver-operating characteristic curves demonstrated a best cut-off value of </=5.2 mmol/l (200.8 mg/dl) as being the best predictor of mortality at 12 months (sensitivity 80.0%, specificity 62.9%). In the validation population, one-year survival was 88% (95% CI 84 to 91%) and three-year survival was 68% (95% CI 63 to 73%). The chance of survival increased 25% for each mmol/l increment in total cholesterol. Survival rates above and below the cut-off value for cholesterol in patients with ischemic heart disease (n = 181) were 92% (95% CI 89 to 94) versus 75% (95% CI 64 to 85%) at one year and 72% (95% CI 67 to 76%) versus 50% (95% CI 43 to 56%) at three years.

Conclusions: In patients with CHF, lower serum total cholesterol is independently associated with a worse prognosis.

MeSH terms

  • Age Factors
  • Cholesterol / blood*
  • Chronic Disease
  • Exercise Tolerance
  • Heart Failure / blood
  • Heart Failure / mortality*
  • Humans
  • Lipoproteins / blood
  • Middle Aged
  • Prognosis
  • ROC Curve
  • Sensitivity and Specificity
  • Stroke Volume
  • Survival Rate


  • Lipoproteins
  • Cholesterol