Low cholesterol associated with enhanced risk of death in heart failure patients

‘Heart failure’ is a term used by doctors to describe a state where the heart muscle has become quite ineffective at pumping blood around the body. This problem can manifest in a variety of ways including fatigue, breathlessness, swelling (oedema) in the lower legs and fluid build-up in the lungs (pulmonary oedema). Ultimately, the condition can prove fatal. Heart failure can be caused by one or more of several factors including ‘heart disease’ (‘furring up’ of the arteries that supply blood to the heart muscle), persistently raised blood pressure and disease of the heart muscle itself (cardiomyopathy).

While raised cholesterol levels are often said to be bad news for the heart, I was interested to read a recently published piece of research which assessed the relationship between cholesterol levels and health outcomes in individuals suffering from heart failure. In this US-based study, about 2,500 people were assessed for an average of almost 3 years [1]. The researchers compared levels of supposedly unhealthy low-density lipoprotein cholesterol (LDL-C) and overall risk of death during the period of the study.

What the researchers found is that individuals with LDL-C cholesterol levels < 1.84 mmol/l (71 mg/dl ) were, overall, at a 68 per cent increased risk of death compared to individuals whose LDL-C levels were significantly higher (> 3.36 mmol/l = 130 mg/dl).

This study, though, is not a one-off. Previous research has also linked lower levels of cholesterol with worse outcomes in those suffering from heart failure. In one study published in 2006, lower levels of total cholesterol were found to be associated with increased risk of death in patients with heart failure. The authors of this study concluded that: “Further research is necessary to determine the nature of this relationship, optimal lipid levels, and the therapeutic role, if any, of statins in patients with established [heart failure].”

I think the caution these researchers advise in the use of statins in individuals with heart failure is relevant for two reasons. Firstly, statins may reduce cholesterol to levels associated with worse outcomes. Secondly, though, statins can deplete the body of the nutrient coenzyme Q10. Coenzyme Q10 contributes to muscle function, and low levels of it can conceivably compromise the functioning of the heart (the heart is a muscle, after all). The last thing we want to be doing, in my opinion, is weakening a muscle that is, by definition, already weakened.

References:

1. Kahn MR, et al. Low-Density Lipoprotein Levels in Patients With Acute Heart Failure. Congest Heart Fail 2012 Oct 16. [Epub ahead of print]

2. Afsarmanesh N, et al. Total cholesterol levels and mortality risk in nonischemic systolic heart failure. Am Heart J. 2006;152(6):1077-83

10 Responses to Low cholesterol associated with enhanced risk of death in heart failure patients

  1. Lorna 27 October 2012 at 4:24 pm #

    Have just started reading ‘Bad Pharma’ by Ben Goldacre. One chapter in and I am reeling from the (now) obvious distortions of medical trials that arrive at medications for the masses. I would urge everyone with an enquiring mind to take a look at this very readable and startling book.

  2. Georgia Ede MD 27 October 2012 at 8:41 pm #

    “The last thing we want to be doing…is weakening a muscle that is, by definition, already weakened.” Huzzah! It is sentences like this that make me a Dr. Briffa fan:)

  3. Cybertiger 28 October 2012 at 4:51 pm #

    @Lorna

    Is there anything in Ben’s book about the vaccine-industrial-complex and the lengths the vaccine industrialists will go to protect policy and profit? Not a lot I suspect. Vaccine safety science is Bad-Ben’s Achilles heel.

  4. Lorna 28 October 2012 at 6:23 pm #

    @ Cybertiger
    Looked in index and no vaccine reference. I have a cousin who was ‘vaccine’ damaged (although 50 years ago that was a question that was never resolved by the parents who had a healthy baby then a very poorly one who had speech and mobility issues from 6 months old). For me, the issue is the way information is witheld and manipulated. I have no scientific training but teach, amongst other things, A Level Critical Thinking. If any area ever needed more critical thinking than the quality of people’s lives as a result of medicine and medical research, then this is it. Anyone who has the commitment to presenting information to the layperson in a way that we can absorb and carefully consider is worth reading. Currently getting to grips with ‘blobbographs’ and the implications in Ben Goldacre’s book are shocking (see Page 17 on trials of intravenous streptokinase). All the best! Lorna

  5. Andre 28 October 2012 at 7:16 pm #

    LDL – the large-fluffy kind – is part of the immune system. That’s why low LDL is also linked to high cancer risk. Driving down cholesterol is stupid, if you want to grow old.

    It’s the small dense particle LDL that promotes inflamation and is capable of entering the vessel wall.

    How to avoid them? Reduce the carb intake.

  6. PeggyC 29 October 2012 at 3:01 am #

    @Cybertiger, You’re wrong. Anti-vaccine “science” is what’s bad. There’s not a whole lot of profit in vaccines to protect and policy protects people, especially children. Including unborn children. I find it sad that, even after all this time, people are still buying into the anti-vaccination propaganda. The fact that Ben Goldacre doesn’t is a good thing. Don’t want to hijack the current thread, but could not let that one go. Sorry.

  7. Cybertiger 30 October 2012 at 10:35 pm #

    @PeggyC

    Who was on trial in the recent re-run of Kafka’s?

    http://qjmed.oxfordjournals.org/content/103/7/541.full.pdf

    And why? Please think about it. Think about the lengths that people will go to protect policy and profit.

  8. Cybertiger 30 October 2012 at 11:47 pm #

    @PeggyC

    “Medicine is broken” were the opening words of Ben Goldacre’s recent book. ‘Bad Ben’ is right of course, but in omitting any mention of the outrageous failures in industrial vaccine safety research he has only seen fit to tell half the story of pharma corruption. Why’s that I wonder.

  9. Dr. Bill Wilson 1 November 2012 at 9:04 pm #

    Although some selective patients may benefit from statins, in my opinion they are greatly over-prescribed. All patients taking statins should also take coenzyme Q10 as a supplement. I also use the combination of coenzyme Q10 and D-ribose to treat patients with CHF.

    Recent research is suggesting that the healthiest diet is a low carbohydrate, moderate protein, high fat diet, assuming the fat is healthy fat like coconut oil, olive oil, omega 3 fat and avocados. Heart cells have less mitochondria than other cells and thus fat is a better source of energy for heart cells than glucose. High fat for heart disease? Isn’t this the exact opposite of the dogma for the past 50 years? Yes it is, but it’s time to change our dogma went the current approach isn’t working so well.

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