Cholesterol — A marker of nutritional status in mild to moderate heart failure

Objective To assess the association between serum cholesterol and nutritional status in patients with stable mild to moderate chronic heart failure (CHF). Background Hypercholesterolemia is a well-established risk factor for mortality and morbidity in coronary heart disease. In an apparent paradox, lower serum cholesterol has been associated with worse prognosis in CHF. Pre-albumin is the preferred marker for undernutrition in chronic diseases. Methods We evaluated 92 CHF patients, mean age 68 years, mean body mass index 27 kg/m2; 44 with ischemic etiology; 41 in New York Heart Association class I. Patients were included after a period of at least 2 months of clinical stability. Spearmanʹs correlation coefficient between serum cholesterol and pre-albumin, both in the whole sample and stratifying by the use of statins was calculated. Results Median (interquartile range) cholesterol level was 174 (142–214) mg/dl and median pre-albumin level was 31 (25–37) mg/dl. Overall, there was a moderately strong and statistically significant positive correlation between pre-albumin and serum cholesterol (Rho = 0.57, p < 0.001). Among the 20 patients not on statin the correlation coefficient was 0.84 (p < 0.001), while among the 72 patients under a statin the correlation was 0.49 (p < 0.001). Conclusion Our results suggest that in stable mild to moderate CHF patients, cholesterol levels are closely related with nutritional status irrespective of therapy with a statin.