Low high-density lipoprotein predicts death in patients with mild left ventricular dysfunction regardless of coronary atherosclerosis

Objective: Low plasma high-density lipoprotein (HDL)-cholesterol is a major risk factor for cardiovascular diseases. We investigated whether HDL-cholesterol levels had a prognostic value in patients with mild left ventricular dysfunction, irrespective of the presence of coronary disease. Methods: The study included 686 consecutive patients hospitalized between January 2002 and December 2006 because of left ventricular dysfunction. All patients completed a lipid profile and underwent coronary angiography. Patients were followed for a mean period of 23 months, during which major events were recorded. Results: Seventy-three percent of patients were New York Heart Association (NYHA) class I-II, with the mean values of left ventricular ejection fraction and left ventricular end-diastolic diameter being, respectively, 36.3 ± 8.6% and 58.3 ± 7.9 mm. Half of the patients (52%) had HDL values less than 40 mg/dl, 28% presented with HDL less than 35 mg/dl. In multivariable analysis, patients with HDL-cholesterol concentration less than 40 mg/dl showed higher risk for cumulative mortality (HR 1.77, P 0.05) and for cardiac death (HR 2.06, P 0.05). This higher risk was also observed in patients with low HDL-cholesterol levels but without significant coronary stenosis. The inclusion of the C-reactive protein (CRP) inflammation marker into the model highly improved the power of death prediction. Conclusion: In patients with left ventricular dysfunction, regardless of the presence of coronary atherosclerosis, lower HDL-cholesterol was a strong and independent predictor of both cardiac and all-cause death