Kolesterol i kloridi u akutnom zatajivanju srca

Detecting predictors of poor outcome is crucial for understanding the underlying pathophysiology of heart failure (HF) and thus creating new therapeutic concepts. It is well established that low serum lipid levels are associated with unfavorable outcomes in HF patients. Several studies examined the association between serum lipids and established predictors of mortality in HF patients. The aim of the present study was to examine the association of serum lipid and chloride concentrations, as well as their impact on survival in acute heart failure (AHF). The present study was performed as a prospective, single-centre, observational research. The study included 152 patients with AHF. Spearman’s correlation coefficient revealed a significant positive correlation of serum chloride levels with serum levels of total cholesterol (ρ 0.221, p=0.006), low-density lipoprotein cholesterol (LDL-c) (ρ 0.187, p=0.015) and high-density lipoprotein-cholesterol (HDL-c) (ρ 0.169, p=0.038). Binary logistic regression revealed a significant association of chloride, total cholesterol and LDL-c serum levels measured at admission with hospital survival (OR 1.077, CI 1.01-1.154, p=0.034), (OR 1.731, CI 1.090-2.748, p=0.020) and (OR 1.839, CI 1.033-3.274, p=0.038), respectively, as well as with 3-month survival (OR 1.065, CI 1.002-1.131, p=0.042), (OR 1.625, CI 1.147-2.303, p=0.006) and (OR 1.711, CI 1.117-2.622, p=0.014), respectively. In conclusion, positive statistical association between serum cholesterol (total cholesterol, LDL-c and HDL-c) and chloride levels may suggest their similar modulation by AHF pathophysiology. Serum levels of total cholesterol, LDL-c and chloride contribute to patient survival.Otkrivanje pokazatelja lošijeg ishoda u bolesnika s akutnim zatajivanjem srca je od velike važnosti za razumijevanje njegove patofiziologije, a time i za otkrivanje novih terapijskih pristupa. Poznato je da su niske koncentracije lipida u serumu povezane s lošijim ishodom u bolesnika s akutnim zatajivanjem srca. Brojne studije su pokušale utvrditi vezu između koncentracije lipida u serumu i ostalih prediktora lošijeg ishoda u bolesnika s akutnim zatajivanjem srca. Cilj istraživanja bio je istražiti povezanost koncentracije lipida i klorida u serumu kod bolesnika sa zatajivanjem srca te njihov utjecaj na preživljenje. Studija je provedena u obliku prospektivnog opservacijskog istraživanja u jednom bolničkom centru. U istraživanje je bilo uključeno 157 bolesnika s akutnim zatajivanjem srca. Spearmanovi koeficijenti korelacije su pokazali značajnu pozitivnu povezanost koncentracije klorida i ukupnog kolesterola (ρ 0,221, p=0,006), lipoproteina male gustoće (LDL-c) (ρ 0,187, p=0,015) i lipoproteina velike gustoće (HDL-c) (ρ 0,169, p=0,038). Binarnom logističkom regresijom je uočena statistički značajna povezanost koncentracije klorida, ukupnog kolesterola i LDL-c u bolesnika s akutnim zatajivanjem srca prilikom prijma bolesnika u bolnicu i unutarbolničkog preživljenja (OR 1,077, CI 1,01-1,154, p=0,034), (OR 1,731, CI 1,090-2,748, p=0,020) i (OR 1,839, CI 1,033-3,274, p=0,038), kao i preživljenja nakon tri mjeseca (OR 1,065, CI 1,002-1,131, p=0,042), (OR 1,625, CI 1,147-2,303, p=0,006) i (OR 1,711, CI 1,117-2,622, p=0,014). Zaključno, pozitivna statistička povezanost između koncentracije kolesterola u serumu (ukupni kolesterol, LDL-c i HDL-c) i koncentracije klorida može ukazivati na njihovu sličnu ulogu u patofiziologiji akutnog zatajivanja srca. Koncentracija ukupnog kolesterola, LDL-c i klorida u serumu sudjeluju u preživljenju bolesnika

Metabolic syndrome modulates association between endothelial lipase and lipid/lipoprotein plasma levels in acute heart failure patients

We hypothesised that the established association of endothelial lipase (EL) plasma levels with atherogenic lipid profile is altered in acute heart failure (AHF) and additionally affected by overlapping metabolic syndrome (MetS). We examined the association of EL plasma levels and lipid/lipoprotein plasma levels in AHF patients without and with overlapping MetS. The study was performed as a single-centre, observational study on 152 AHF patients, out of which 85 had overlapping MetS. In the no-MetS group, EL plasma levels were significantly positively correlated with plasma levels of atherogenic lipids/lipoproteins, including total cholesterol, low-density lipoprotein (LDL)-cholesterol, total LDL particles and triglycerides, but also with plasma levels of antiatherogenic high-density lipoprotein (HDL)-cholesterol, total HDL particles and small HDL particles. In the MetS group, EL plasma levels were positively correlated with triglyceride and small LDL-particle levels, and significantly negatively correlated with plasma levels of large HDL particles as well as with LDL- and HDL-particle size, respectively. EL- and lipid/lipoprotein- plasma levels were different in the no-MetS patients, compared to MetS patients. The association of EL with atherogenic lipid profile is altered in AHF and additionally modified by MetS, which strongly modulates EL- and lipid/lipoprotein-plasma levels in AHF

Metrics of high-density lipoprotein function and hospital mortality in acute heart failure patients

OBJECTIVE: The functionality of high-density lipoprotein (HDL) is impaired in chronic ischaemic heart failure (HF). However, the relationship between HDL functionality and outcomes in acute HF (AHF) has not been studied. The present study investigates whether the metrics of HDL functionality, including HDL cholesterol efflux capacity and HDL-associated paraoxonase (PON)-1 arylesterase (AE) activity are associated with hospital mortality in AHF patients. ----- METHODS AND RESULTS: The study was performed as a prospective, single-centre, observational research on 152 patients, defined and categorised according to the ESC and ACCF/AHA Guidelines for HF by time of onset, final clinical presentation and ejection fraction. The mean age of the included patients (52% female) was 75.2 years (SD 10.3) and hospital mortality was 14.5%. HDL cholesterol efflux capacity was examined by measuring the capacity of apoB depleted serum to remove tritium-labelled cholesterol from cultured macrophages. The AE activity of the HDL fraction was examined by a photometric assay. In a univariable regression analysis, low cholesterol efflux, but not AE activity, was significantly associated with hospital mortality [odds ratio (OR) 0.78, 95% confidence interval (CI) 0.64-0.96, p = 0.019]. In multivariable analysis progressively adjusting for important clinical and laboratory parameters the association obtained for cholesterol efflux capacity and hospital mortality by univariable analysis, despite a stable OR, did not stay significant (p = 0.179). ----- CONCLUSION: Our results suggest that HDL cholesterol efflux capacity (but not AE activity) contributes to, but is not an independent risk factor for, hospital mortality in AHF patients. Larger studies are needed to draw firm conclusions

Acute heart failure developed as worsening of chronic heart failure is associated with increased mortality compared to de novo cases

Acute heart failure (AHF) emerges either de novo or from worsening of chronic heart failure (CHF). The aim of the present study was to evaluate the association between worsening of CHF and mortality in AHF patients. Out of 152 included AHF patients, 47 (30.9%) were de novo AHF patients and 105 (69%) were AHF patients with worsening of CHF. The proportion dying in hospital (19.0% vs. 4.3%, p = 0.023) and within 3 months after hospitalization (36.6% vs. 6.7%, p < 0.001) was significantly higher in AHF patients with worsening of CHF. Logistic regression analyses also showed a significant positive association of AHF emerging as worsening of CHF with hospital mortality [odds ratio (OR) and 95% confidence interval (CI): 5.29 (1.46-34.10), p = 0.029] and 3-month mortality [8.09 (2.70-35.03), p = 0.001]. While the association with hospital mortality was no longer significant after adjusting for comorbidities and clinical as well as laboratory parameters known to be associated with mortality in heart failure patients, the association with 3-month mortality remained significant. We conclude that compared to de novo AHF, AHF evolved from worsening of CHF is a more severe condition and is associated with increased mortality

Kolesterol i kloridi u akutnom zatajivanju srca

Detecting predictors of poor outcome is crucial for understanding the underlying pathophysiology of heart failure (HF) and thus creating new therapeutic concepts. It is well established that low serum lipid levels are associated with unfavorable outcomes in HF patients. Several studies examined the association between serum lipids and established predictors of mortality in HF patients. The aim of the present study was to examine the association of serum lipid and chloride concentrations, as well as their impact on survival in acute heart failure (AHF). The present study was performed as a prospective, single-centre, observational research. The study included 152 patients with AHF. Spearman’s correlation coefficient revealed a significant positive correlation of serum chloride levels with serum levels of total cholesterol (ρ 0.221, p=0.006), low-density lipoprotein cholesterol (LDL-c) (ρ 0.187, p=0.015) and high-density lipoprotein-cholesterol (HDL-c) (ρ 0.169, p=0.038). Binary logistic regression revealed a significant association of chloride, total cholesterol and LDL-c serum levels measured at admission with hospital survival (OR 1.077, CI 1.01-1.154, p=0.034), (OR 1.731, CI 1.090-2.748, p=0.020) and (OR 1.839, CI 1.033-3.274, p=0.038), respectively, as well as with 3-month survival (OR 1.065, CI 1.002-1.131, p=0.042), (OR 1.625, CI 1.147-2.303, p=0.006) and (OR 1.711, CI 1.117-2.622, p=0.014), respectively. In conclusion, positive statistical association between serum cholesterol (total cholesterol, LDL-c and HDL-c) and chloride levels may suggest their similar modulation by AHF pathophysiology. Serum levels of total cholesterol, LDL-c and chloride contribute to patient survival.Otkrivanje pokazatelja lošijeg ishoda u bolesnika s akutnim zatajivanjem srca je od velike važnosti za razumijevanje njegove patofiziologije, a time i za otkrivanje novih terapijskih pristupa. Poznato je da su niske koncentracije lipida u serumu povezane s lošijim ishodom u bolesnika s akutnim zatajivanjem srca. Brojne studije su pokušale utvrditi vezu između koncentracije lipida u serumu i ostalih prediktora lošijeg ishoda u bolesnika s akutnim zatajivanjem srca. Cilj istraživanja bio je istražiti povezanost koncentracije lipida i klorida u serumu kod bolesnika sa zatajivanjem srca te njihov utjecaj na preživljenje. Studija je provedena u obliku prospektivnog opservacijskog istraživanja u jednom bolničkom centru. U istraživanje je bilo uključeno 157 bolesnika s akutnim zatajivanjem srca. Spearmanovi koeficijenti korelacije su pokazali značajnu pozitivnu povezanost koncentracije klorida i ukupnog kolesterola (ρ 0,221, p=0,006), lipoproteina male gustoće (LDL-c) (ρ 0,187, p=0,015) i lipoproteina velike gustoće (HDL-c) (ρ 0,169, p=0,038). Binarnom logističkom regresijom je uočena statistički značajna povezanost koncentracije klorida, ukupnog kolesterola i LDL-c u bolesnika s akutnim zatajivanjem srca prilikom prijma bolesnika u bolnicu i unutarbolničkog preživljenja (OR 1,077, CI 1,01-1,154, p=0,034), (OR 1,731, CI 1,090-2,748, p=0,020) i (OR 1,839, CI 1,033-3,274, p=0,038), kao i preživljenja nakon tri mjeseca (OR 1,065, CI 1,002-1,131, p=0,042), (OR 1,625, CI 1,147-2,303, p=0,006) i (OR 1,711, CI 1,117-2,622, p=0,014). Zaključno, pozitivna statistička povezanost između koncentracije kolesterola u serumu (ukupni kolesterol, LDL-c i HDL-c) i koncentracije klorida može ukazivati na njihovu sličnu ulogu u patofiziologiji akutnog zatajivanja srca. Koncentracija ukupnog kolesterola, LDL-c i klorida u serumu sudjeluju u preživljenju bolesnika

Cholesterol Content of Very-Low-Density Lipoproteins Is Associated with 1-Year Mortality in Acute Heart Failure Patients

Considering the relationship between the extent of metabolic derangement and the disease severity in heart failure, we hypothesized that the lipid content of very-low-density lipoprotein (VLDL) may have prognostic value for 1 year mortality in acute heart failure (AHF). Baseline serum levels of VLDL cholesterol (VLDL-C), VLDL triglycerides (VLDL-TG), VLDL phospholipids (VLDL-PL), and VLDL apolipoprotein B (VLDL-apoB) were measured using NMR spectroscopy. We calculated the ratios of the respective VLDL lipids and VLDL apoB (VLDL-C/VLDL-apoB, VLDL-TG/VLDL-apoB, and VLDL-PL/VLDL-apoB), as estimators of the cholesterol, triglyceride, and phospholipid content of VLDL particles and tested their association with mortality. Out of 315 AHF patients, 118 (37.5%) patients died within 1 year after hospitalization for AHF. Univariable Cox regression analyses revealed a significant inverse association of VLDL-C/VLDL-apoB (hazard ratio (HR) 0.43, 95% confidence interval (CI) 0.29–0.64, p < 0.001), VLDL-TG/VLDL-apoB (HR 0.79, 95% CI 0.71–0.88, p < 0.001), and VLDL-PL/VLDL-apoB (HR 0.37, 95% CI 0.25–0.56, p < 0.001) with 1 year mortality. Of the tested parameters, only VLDL-C/VLDL-apoB remained significant after adjustment for age and sex, as well as other clinical and laboratory parameters that showed a significant association with 1 year mortality in the univariable analyses. We conclude that cholesterol content of circulating VLDL (VLDL-C/VLDL-apoB) might be of prognostic value in AHF

Baseline characteristics, biochemical laboratory parameters, comorbidities, and classification of AHF patients (n = 152).

<p>Baseline characteristics, biochemical laboratory parameters, comorbidities, and classification of AHF patients (n = 152).</p

Univariable logistic regression analysis of HDL function, clinical and laboratory parameters and hospital mortality.

<p>Univariable logistic regression analysis of HDL function, clinical and laboratory parameters and hospital mortality.</p

Pearson correlation of clinical and laboratory variables with HDL AE activity and cholesterol efflux capacity.

<p>Pearson correlation of clinical and laboratory variables with HDL AE activity and cholesterol efflux capacity.</p

Multivariable logistic regression analysis of hospital mortality.

<p>Multivariable logistic regression analysis of hospital mortality.</p