Differential effects of lipids on the risk of heart failure and coronary heart disease: The Physicians' Health Study

doi:10.1016/j.ahj.2007.12.023

American Heart Journal

Volume 155, Issue 5, May 2008, Pages 869-875

https://doi.org/10.1016/j.ahj.2007.12.023 Get rights and content

Background

It is understood that coronary heart disease (CHD) is one cause of heart failure, and many risk factors are common to both entities. Hypercholesterolemia, however, being a well-recognized risk factor for CHD, has an unclear association with incident heart failure.

Methods

We evaluated the relations of total and high-density lipoprotein (HDL) cholesterol to incident heart failure and CHD in 10 813 US male physicians (mean age, 68 years). Total and HDL cholesterol were analyzed both as continuous and as categorical (in quartiles) variables.

Results

There were 222 incident heart failure cases on follow-up (mean, 6 years). In Cox models, after adjusting for traditional coronary risk factors, 1-SD increase in total cholesterol (36.7 mg/dL) and HDL cholesterol (15.3 mg/dL) was not related to incident heart failure with a hazard ratio and 95% CI of 0.91 (0.79-1.05) for total cholesterol and 0.95 (0.82-1.11) for HDL cholesterol. In categorical models, heart failure risk in second, third, and fourth quartiles of total and HDL cholesterol was statistically not different from those in the lowest quartile; hazard ratios with 95% CI were 0.72 (0.49-1.05), 0.76 (0.52-1.11), 0.73 (0.50-1.09) for total cholesterol, and 0.78 (0.53-1.15), 0.66 (0.43-1.00), and 1.03 (0.69-1.54), for HDL cholesterol. Further adjustment for CHD on follow-up or exclusion of individuals with CHD at baseline did not alter the results. In contrast, high total cholesterol and low HDL cholesterol increased the risk of incident CHD (P < .001).

Conclusion

In healthy males, total and HDL cholesterol levels were not related to incident heart failure.

Section snippets

Methods

The design and selection criteria of Physicians' Health Study (PHS) have been described previously.19, 20 Briefly, 22 071 apparently healthy male physicians without prior history of cardiovascular disease, cancer, liver disease, or renal dysfunction were randomized in 1982 to test the effect of aspirin and beta carotene in a 2 × 2 factorial design. In 1988, the aspirin arm was stopped early after showing a 44% reduction in the occurrence of first MI, whereas the beta carotene arm went through

Baseline characteristics

As expected, a greater proportion of participants in the lowest quartile of total cholesterol were on cholesterol-lowering medications (Table I). The prevalence of diabetes mellitus, high blood pressure, and CHD decreased with increasing quartiles of total cholesterol. The distribution of baseline characteristics according to quartiles of HDL cholesterol showed similar trends.

Total and HDL cholesterol to the incidence of heart failure

During a mean follow-up of 6.0 years, 222 individuals developed heart failure, 99 of whom had CHD before the onset of

Principal findings

In the present investigation, incidence of heart failure was not related to levels of total cholesterol or HDL cholesterol. In age-adjusted models, we did observe a significant decrease in risk of heart failure with increasing serum levels of total and HDL cholesterol, but these results became statistically nonsignificant after accounting for established CHD risk factors, and with further adjustment for time-dependent CHD. Similarly, there was no association of total or HDL cholesterol, or for

Conclusion

In our large healthy sample of males free of heart failure, total cholesterol and HDL cholesterol were not associated with incidence of heart failure. If confirmed, additional research studies are required to explore other techniques besides lowering cholesterol in primary prevention of heart failure.

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: Part of the results were presented as an abstract at the AHA annual conference on cardiovascular disease epidemiology and prevention on March 1, 2007, in Orlando, FL.

: The Physicians' Health Study is supported by grants CA-34944, CA-40360, and CA-097193 from the National Cancer Institute and grants HL-26490 and HL-34595 from the National Heart, Lung, and Blood Institute, Bethesda, MD.

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Clinical InvestigationCoronary Artery DiseaseDifferential effects of lipids on the risk of heart failure and coronary heart disease: The Physicians' Health Study

Background

Methods

Results

Conclusion

Section snippets

Methods

Baseline characteristics

Total and HDL cholesterol to the incidence of heart failure

Principal findings

Conclusion

Med Clin North Am

Med Clin North Am

Am J Hypertens

Am Heart J

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Card Fail

Lancet

Ann Epidemiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Heart disease and stroke statistics—2005 Update

The heart, arteries and veins

Profile for estimating risk of heart failure

Arch Intern Med

Cardiac systolic and diastolic dysfunction after a cholesterol-rich diet

Circulation

Relationship between left ventricular mass and serum cholesterol level in the untreated hypertensive

J Hypertens

Clinical Investigation
Coronary Artery Disease
Differential effects of lipids on the risk of heart failure and coronary heart disease: The Physicians' Health Study