Higher LDL levels protect against death following a heart attack or heart failure

Posted by .(JavaScript must be enabled to view this email address)
Wednesday, January 01, 2020 9:48 am Email this article

“Our data support a protective role for [higher LDL levels] against all-cause mortality following incident [heart attack] and [heart failure],” concludes a new study from researchers at the Mayo Clinic.

LDL levels above 130 mg/dL were most protective.

 

Among matched patients who had an acute heart attack, those with LDL levels less than 100 mg/dL were 32% more likely to die during follow-up than people with LDL levels greater than 100 mg/dL.

To say this the other way, people with LDL levels greater than 100 mg/dL were 24% less likely to die during follow-up after an acute heart attack than people with LDL levels less than 100 mg/dL.

Among matched patients who had a worsening of their heart failure, those with LDL levels less than 100 mg/dL were 25% more likely to die during follow-up than patients with LDL levels greater than 100 mg/dL.

To say this the other way, people with LDL levels greater than 100 mg/dL who had a worsening of their heart failure were 20% less likely to die during follow-up than those with LDL levels less than 100 mg/dL.

A meta-analysis of nine (9) studies showed that among people who had an acute heart attack, those with LDL levels greater than 100 mg/dL were 28% less likely to die after 2 or more years than people with LDL levels less than 100 mg/dL.

A meta-analysis of nine (9) studies showed that people who had acute decompensated heart failure, those with LDL levels greater than 100 mg/dL were 33% less likely to die after 2 years or more than people with LDL levels less than 100 mg/dL.

In matched patients who had an acute heart attack, among those with LDL levels less than 100 mg/dL, 62.5% died during an median follow-up of 6.3 years, whereas among people with LDL levels greater than 100 mg/dL, only 50.2% died during an median follow-up of 8.8 years.

In matched patients who had a worsening of their heart failure, among those with LDL levels less than 100 mg/dL, 67.7% died during an median follow-up of 2.5 years, whereas among people with LDL levels greater than 100 mg/dL, only 58.6% died during an median follow-up of 3.2 years.

“In separate analysis, adjustment of Cox proportional model for statin treatment did not change results for baseline [LDL levels greater than 100 mg/dL] in predicting the all-cause mortality,” the authors of the paper noted.

Body Mass Index (BMI) was inversely related to mortality in both those who had an acute heart attack and those who had heart failure.

A one-unit increase in BMI was associated with a 1% reduction in mortality.

 

“We stratified patients into quartiles according to levels of LDL-C,<70 mg/dL, 70–99 mg/dL, 100–129 mg/dL and ≥130 mg/dL. There was a graded reduction in mortality from highest to the lowest LDL-C quartile in both [acute heart attack] and [heart failure]” the authors noted.

 

People who had a heart attack and who had LDL levels of 70-99 mg/dL were 10% less likely to die compared to those who had an LDL of less than 70 mg/dL. (2nd quartile vs 1st quartile.)

 

People who had a heart attack and who had LDL levels of 100-129 mg/dL were 13% less likely to die compared to those who had an LDL of less than 70 mg/dL. (3rd quartile vs 1st quartile.)

 

People who had a heart attack and who had LDL levels of 130 mg/dL or greater were 17% less likely to die compared to those who had an LDL of less than 70 mg/dL. (4th quartile vs 1st quartile.)

 

People who had heart failure who had LDL levels of 70-99 mg/dL were 11% less likely to die compared to those who had LDL levels less than 70 mg/dL.

 

People who had heart failure who had LDL levels of 100-129 mg/dL were 18% less likely to die compared to those who had LDL levels less than 70 mg/dL.

 

People who had heart failure who had LDL levels of 130 mg/dL or more were 23% less likely to die compared to those who had LDL levels less than 70 mg/dL.

 

“The association was consistent across the following subsets: young and old, male and female, white and nonwhite, and prevailed across both study cohorts,” the authors noted.

 

“The reductions in mortality were independent of benefit attributable to statin therapy,” the authors noted.

 

“Findings of this study dispute general assumption that [elevated LDL levels] is associated with increased mortality,” they note.

 

“Previous studies reported that even healthy subjects with low cholesterol are especially predisposed to infectious diseases.”

 

“Our data support a protective role for [higher LDL levels] against all-cause mortality following incident [heart attack] and [worsening heart failure].”

 

Reference

Yousufuddin M, Takahashi PY, Major B, Ahmmad E, Al-Zubi H, Peters J, Doyle T, Jensen K, Al Ward RY, Sharma U, Seshadri A, Wang Z, Simha V, and Murad MH. Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis. BMJ Open, 2019 Dec 15; 9(12): e028638.

Author’s Contact Info

Dr Mohammed Yousufuddin Internal Medicine Mayo Clinic Minnesota Rochester, Minnesota, USA .(JavaScript must be enabled to view this email address)

Articles on the same subject can be found here:

• Cholesterol

• Cholesterol, LDL

• Congestive Heart Failure

• Heart Attack (myocardial infarction)