Higher serum cholesterol levels linked to better survival after LVAD implantation

By Will Boggs MD

NEW YORK (Reuters Health) - Higher levels of serum cholesterol three months after implantation of a left ventricular assist device (LVAD) are associated with improved survival, according to a new study.

"I was very interested to find such a strong association between recovery of total cholesterol levels in the first three months of LVAD support and subsequent survival on LVAD support, because this adds weight to our hypothesis that 'metabolic recovery' is an important element of treating advanced heart failure," Dr. Amanda R. Vest from Tufts Medical Center, Boston, Massachusetts told Reuters Health by email.

Lower serum levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides are associated with worse outcomes in heart failure, and patients with lower cholesterol levels have higher perioperative mortality after LVAD implantation.

Dr. Vest and colleagues used data from two high-volume LVAD implantation centers - Cleveland Clinic and Columbia University Medical Center - to define the impact of LVAD implantation on lipid profiles in advanced heart failure with reduced ejection fraction and to determine whether changes in cholesterol levels after LVAD implantation affect survival during LVAD support.

Total cholesterol, LDL, HDL, and triglyceride levels all increased significantly from the time of implantation to three months post-LVAD implantation, the team reports in Circulation: Heart Failure, online September 9.

After adjustment for other factors, the improvement in total cholesterol from baseline to three months post-LVAD remained a significant predictor of survival on LVAD support. Patients whose cholesterol recovery was above the median had a 76% lower adjusted mortality risk during LVAD support compared with other patients.

The three-month total cholesterol threshold for transitioning into a more favorable mortality risk was approximately 130 mg/dL, with the lowest adjusted mortality hazard occurring at approximately 170 mg/dL.

Triglyceride recovery - but not LDL or HDL recovery - was also associated with lower mortality during LVAD support.

The researchers concede that "our retrospective analysis does not exclude the possibility that cholesterol recovery is simply a bystander of improved overall metabolic state after hemodynamic improvement."

"Although we have not directly studied the impact of statins in LVAD patients, these results do challenge clinicians to reconsider the use of high-potency statins in advanced heart failure, because lower total cholesterol levels after three months of LVAD support were associated with worse outcomes," Dr. Vest said.

"This analysis further increases our enthusiasm for understanding the phenomenon of 'metabolic recovery' which we see when advanced heart failure is reversed by mechanical support," she said.

"It has previously been noted that high glucose levels, insulin resistance, and low albumin levels also tend to improve after LVAD implantation. The abnormalities of cholesterol and glucose metabolism that accompany heart failure haven't been as well studied as the abnormalities of salt and water regulation, and so we do not yet know whether influencing the systemic metabolism would be a useful treatment approach for heart failure patients," Dr. Vest added.

SOURCE: https://bit.ly/2cqsjGW

Circ Heart Fail 2016.