Prognostic significance of serum cholesterol levels in patients with idiopathic dilated cardiomyopathy

Aims Previous studies indicate that low cholesterol levels are associated with adverse prognosis in heart failure patients, because elevated lipoprotein levels may negate bacterial endotoxin load induced by gastrointestinal congestion. Methods and results We examined the prognostic significance of lipid levels in a cohort of 422 patients with idiopathic dilated cardiomyopathy (iDCM) [50 +/- 12 years, 342 males, 80 females, left ventricular ejection fraction (LV-EF): 31.6 +/- 10.6%]. During 42 months of follow-up, 86 patients (20.3%) died or received a heart transplant. In univariate Cox regression analysis, reduced LV-EF, high New York Heart Association (NYHA) class, and increased LV end-diastolic diameter (LVEDD) were strong risk factors associated with that endpoint, whereas decreased total cholesterol, HDL-cholesterol, and apoprotein I levels were identified as weak risk predictors. After step-wise multivariable analysis, only LVEDD, NYHA class, and LV-EF emerged as parameters independently contributing to the model predicting risk for death or heart transplantation (P < 0.05). Cholesterol levels were positively associated with LV-EF and negatively associated with LVEDD (P < 0.05). Circulating sCD14 levels, a marker of endotoxin exposure, were related to cholesterol levels (P < 0.05) and LV-EF (P < 0.05). Conclusion Decreased cholesterol levels do not independently predict adverse prognosis in patients with iDCM. Our findings indicate that low cholesterol levels are dependent on the severity of cardiac disease.