A longitudinal 20 years of follow up showed a decrease in the survival of heart failure patients who maintained low LDL cholesterol levels.

BACKGROUND: Treatment by statins is well established for primary and secondary prevention of cardiac events but may be hazardous for patients with heart failure (HF). AIM: We studied the long-term (20 years) association between baseline low-density lipoprotein cholesterol (LDL-c) levels and clinical outcome in patients with severe HF. DESIGN: Patients were divided into those with plasma LDL-c levels 110 mg/dl (Group 1) or >110 mg/dl (Group 2). METHODS: The mean follow-up of 305 study patients with advanced HF who had an average NYHA score of 2.7 was 11.3 years (range 15 months to 20 years). Mortality during follow-up was 43%. RESULTS: Patients with the highest baseline LDL-c levels had significantly improved outcome, whereas those with the lowest LDL-c levels had the highest mortality. This paradoxical effect was prominent in patients <70 years old. The negative association of LDL-c levels and mortality was most conspicuous among the HF patients who were treated with statins. DISCUSSION AND CONCLUSION: Long-term follow-up findings showed that low LDL-c levels may predict a less favorable outcome in advanced HF, particularly in patients <70 years old and those taking statins. This negates the protocol of following an aggressive LDL-c-lowering strategy in younger patients with HF.