Low cholesterol levels are strongly associated with increased mortality in patients with nonischemic, systolic heart failure

This study was published in the American Heart Journal 2006 Dec;152(6):1077-83.

Study title and authors:
Total cholesterol levels and mortality risk in nonischemic systolic heart failure.

Afsarmanesh N, Horwich TB, Fonarow GC.
Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, CA, USA.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/17161056

Nonischemic heart disease is a disease of the heart that lacks the associated coronary artery disease often found in other diseases of the heart. It's usually linked to a disease in one or more of the cardiac muscles, causing the heart to pump in an ineffective manner, thereby reducing the transport of blood, oxygen and other nutrients throughout the body. One of the more common nonischemic heart diseases is dilated cardiomyopathy. In this form of heart disease, your left ventricle has weakened (low left ventricular ejection fraction (LVEF)) to the point where it can no longer pump enough blood.

Hemodynamics is a measurement of blood pressure and blood flow.

The New York Heart Association (NYHA) Functional Classification provides a simple way of classifying the extent of heart failure. It places patients in one of four classes based on how much they are limited during physical activity. E.g. Class one indicates: No symptoms and no limitation in ordinary physical activity, whilst class four is defined as: Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients.

The study analyzed the cholesterol levels of 614 patients with nonischemic systolic heart failure who had a left ventricular ejection fraction less than 40%.

The study found:
(a) Patients with lower cholesterol levels had a lower left ventricular ejection fraction.
(b) Patients with lower cholesterol levels had worse hemodynamic profiles.
(c) Patients with lower cholesterol levels had a higher New York Heart Association class.
(d) Patients with lower cholesterol died earlier.
(e) Patients with lower cholesterol had an increased risk of urgent transplant.

To conclude: Low cholesterol levels are strongly associated with increased mortality in patients with nonischemic, systolic heart failure.