All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor ----------------------------------------------------------- NOTE: You can make the print bigger with the font button on your browser! (It's usually a big "A") ---------------------------------------------------------- Low Cholesterol May Not Help CHFers American College of Cardiology [ACC] (December 9, 2003) - In a study of 417 patients with chronic heart failure, higher cholesterol level was linked to increased survival. Dr. Andrew Clark co-authored the study. Dr. Clark said that heart failure is a condition that stresses the body's metabolism. Perhaps a high cholesterol level helps since it may indicate more reserve to deal with metabolic stress. In the trial, survival increased 25% for each mmol/l (about 39 mg/dl) increase in total cholesterol. On average, patients with a total cholesterol level of 6 mmol/l (about 232 mg/dl) had a 25% higher survival rate than heart failure patients with total cholesterol of 5 mmol/l (about 193 mg/dl). These results agree with an earlier study that linked lower cholesterol to worse outcome in CHFers. Dr. Clark has some ideas about the "why." He said that cholesterol (lipoproteins) absorb bacteria toxins. Perhaps the immune system reaction in CHF is related to bowel wall edema, which allows bacteria into the body. Maybe lipoproteins mop up bacteria before they cause immune system over-activity. THIS STUDY DOES NOT MEAN THAT LOW CHOLESTEROL CAUSES DEATH IN CHFERS! Cholesterol level may be a marker of some other factor, or may be changed by heart failure itself. This was a 2-stage study. The first stage studied the link between cholesterol level and mortality in 114 chronic CHFers treated at a hospital's CHF clinic. The link between lower cholesterol and higher mortality was then verified in a second group of 303 CHFers who had their cholesterol levels measured as part of their regular care. These researchers now want cholesterol lowering drugs called statins studied in new trials of CHFers. Some previous trials suggest that statins may help CHFers, even though they lower cholesterol level. Researchers want to know whether these drugs really help or hurt overall in heart failure patients. In an editorial, Dr. Gregg Fonarow and Dr. Tamara Horwich say that lower cholesterol levels - which are good in the general population and in patients with coronary artery disease - do not help patients with heart failure. These trial results, however, don't claim that low cholesterol was the actual cause of worse outcomes in the CHFers. Jon's note: So what about CHFers with coronary artery disease? What cholesterol level should they try to achieve? This trial just raises questions - it does not answer a single one. ----------------------------------------------------- The Doctor's Reaction From Medscape By Dr. Mary Pickett December 10, 2003 - In the general population, high LDL cholesterol increases the chance that you will have a heart attack. Cholesterol-lowering drugs called statins reduce the average person's risk of heart attack, and thus his risk of developing heart failure. However, cholesterol numbers may mean something different if a person already has CHF. This small study and one earlier study show a link between very low cholesterol numbers and shorter survival in CHFers. Such relationships can be deceiving, so we need to be careful what conclusions we draw. This study did not look backwards to see if cholesterol was low before heart failure developed in these people. Although doctors in the news say that higher cholesterol may benefit CHFers, these are only guesses. It is possible that over time, CHF causes cholesterol to dip downward. If that is true, low cholesterol would be a sign of worsening CHF, not a cause of it. Heart failure is complex. The body senses terrible danger when the heart fails, and the body's metabolism shifts into a whole different mode. Hormone levels change drastically and nutrients have a different effect, Since cholesterol is the body's way of packaging and delivering fats throughout the body, low cholesterol levels may be one sign that the body has "canceled" normal operations and is reacting to a "state of emergency." What Do I Do If I Have Heart Failure? If you have CHF and are being treated for high cholesterol, should you stop the cholesterol-lowering drug? We don't think so. This study was too small and limited to make conclusions about whether lowering high cholesterol levels in people who already have heart failure helps or hurts, or whether it has no effect on survival at all. Other studies show a survival advantage for CHFers taking statin drugs. We just don't know yet how to judge these results. Larger, carefully designed trials are needed.