Biomedical papers, 2012 (vol. 156), issue 1

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2012, 156(1):21-22 | 10.5507/bp.2012.015

Gender differences in total cholesterol levels in patients with acute heart failure and its importance for short and long time prognosis

Lenka Spinarovaa, Jindrich Spinarb, Jiri Vitoveca, Ales Linhartc, Petr Widimskyd, Marian Fedorcoe, Filip Malekf, Cestmir Cihalikg, Roman Miklikb, Ladislav Dusekh, Klaudia Zidovaa, Jiri Jarkovskyh, Simona Littnerovah, Jiri Parenicab
a Internal Cardioangiology Department, University Hospital St. Ann and Faculty of Medicine, Masaryk University Brno, Czech Republic
b Internal Cardiology Department University Hospital Brno and Faculty of Medicine Masaryk University Brno
c 2nd Department of Internal Cardiovascular Medicine, First Medical Faculty, Charles niversity in Prague and General University Hospital in Prague
d Cardiocenter, University Hospital Kralovske Vinohrady and the Third Faculty of Medicine, Charles University in Prague
e Department of Internal Medicine I - Cardiology, University Hospital Olomouc
f Department of Cardiology, Na Homolce Hospital, Prague
g Internal Cardiology Department, T. Bata Regional Hospital, Zlin
h Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University Brno, for the AHEAD investigators

Aim: The purpose of this study was to evaluate whether there are gender differences in total cholesterol levels in patients with acute heart failure and if there is an association of this parameter with short and long time mortality.

Methods: The AHEAD MAIN registry is a database conducted in 7 university hospitals, all with 24 h cath lab service, in 4 cities in the Czech Republic. The database included 4 153 patients hospitalised for acute heart failure in the period 2006-2009. 2 384 patients had a complete record of their total cholesterol levels. 946 females and 1437 males were included in this analysis. According to the admission total cholesterol levels, patients were divided into 5 groups: < 4.50 mmol/l (group A), 4.50-4.99 mmol/l (group B), 5.0-5.49 mmol/l (group C), 5.50-5.99 mmol/l (group D) and > 6.0 mmol/l (group E). The median total cholesterol levels were 4.24 in males and 4.60 in females (P<0.001). There were differences in the distribution of total cholesterol levels between men and women: group A 57.6 vs 45.0%, group B 13.8 vs 16.3%, group C 9.8 vs 12.5%, group D 7.7 vs 11.4%, group E 11.1 vs 14.8% respectively (all P<0.001). The median age of men was 68.7 vs 77.3 years in women (P<0.001). In all total cholesterol categories women were older than men: group A 77.7 vs 69.5 years, group B 78.6 vs 69.1 years, group C 77.3 vs 68.8 years, group D 76.8 vs 64.2 years, group E 75.6 vs 64.4 years (all P<0.001). For the calculation of long term mortality, the cohort was divided into three groups: total cholesterol levels below 4.50 mmol/l, 4.50-5.49 mmol/l and above 5.50 mmol/l. The log rank test was used for the analysis.

Results: There were no differences in hospital mortality between male and female in general (9.2 vs 10.8%, P<0.202), or in total cholesterol levels in subgroups. Total cholesterol levels were associated with in-hospital mortality (P<0.002). In the long-term follow up (78 months) patients with total cholesterol levels below 4.5 mmol/l had the worst prognosis (P<0.001). An independent influence of total cholesterol level on mortality and survival was confirmed in the multivariate model as well.

Conclusions: Women with acute heart failure had higher total cholesterol levels than men in all ages. There was a higher percentage of women with total cholesterol levels above 6 mmol/l and lower percentage in the group below 4.5 mmol/l than in men. In all, total cholesterol categories women were older than men. Total cholesterol levels are important for in- hospital mortality and long term survival of patients admitted for acute heart failure.

Keywords: acute heart failure, AHEAD, cholesterol, gender, in-hospital mortality, prognosis

Received: September 6, 2011; Accepted: January 24, 2012; Prepublished online: February 17, 2012; Published: March 1, 2012


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