Lower
cholesterol levels are associated with worse outcomes in patients with chronic
heart failure (HF) and have been shown to predict in-hospital mortality. The relation between
lipid profile and postdischarge outcomes in patients hospitalized for worsening HF is less clear. In this post hoc analysis of the Efficacy of
Vasopressin Antagonism in
Heart Failure Outcome Study With
Tolvaptan (EVEREST), 3,957 patients hospitalized for worsening HF with ejection fractions ≤40% were examined. Baseline total
cholesterol and
triglyceride levels were measured <48 hours after admission and evaluated as continuous variables. The primary end points of all-cause mortality and cardiovascular mortality or hospitalization for HF were compared using Cox regression models. Patient characteristics at randomization were also compared among quartiles of total
cholesterol. Patients with lower total
cholesterol tended to have lower blood pressure, ejection fractions, serum
sodium, and
albumin, and were more likely to have worse HF functional class, to have higher
natriuretic peptide levels, and to have histories of
diabetes mellitus,
renal insufficiency, and coronary revascularization (all p values <0.001). After adjustment for baseline clinical risk factors, total
cholesterol was predictive of all-cause mortality (hazard ratio 0.73, 95% confidence interval 0.63 to 0.85, p <0.001) and cardiovascular mortality or hospitalization for HF (hazard ratio 0.73, 95% confidence interval 0.66 to 0.82, p <0.001) at median follow-up of 9.9 months. Lower baseline
triglyceride level was also associated with worse outcomes. In conclusion, lower baseline total
cholesterol is correlated with a high-risk patient profile and is a marker of disease severity in patients hospitalized for worsening HF with reduced ejection fraction. Baseline total
cholesterol and
triglyceride levels are predictive of mortality and HF
rehospitalization beyond traditional risk factors.