Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
LDL-C cut-off in Heart Failure– should we follow the guidelines?
Session:
Sessão de Comunicações Orais - Insuficiência Cardíaca
Speaker:
Beatriz Valente Silva
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Beatriz Silva ; Catarina Duarte; Joana Brito; João Pedro Ribeiro Agostinho; Sara Couto Pereira; Rafael Santos; Nelson P. Cunha; Pedro Alves Da Silva; Pedro Silvério António; Pedro Morais; Fausto José Pinto; Dulce Brito
Abstract
<p><strong>Introduction: </strong>The 2019 ESC guidelines on dyslipidaemia management recommend tighter LDL-cholesterol (LDL) control in order to prevent cardiovascular (CV) events. However, it is not yet proven that aggressive treatment of dyslipidaemia in Heart Failure (HF) patients (pts) has an impact on prognosis, and some published data even suggest that a tight control in these pts may be deleterious. Also, the same effect may be expected with aggressive body mass index (BMI) lowering or poor glycemic control.</p> <p><strong>Objective:</strong> to evaluate the impact of LDL-C, HbA1c and BMI on HF pts mortality rate.</p> <p><strong>Methods: </strong>Single center study that included consecutive pts hospitalized for acute/decompensated chronic HF in a tertiary Hospital between January 2016 and December 2018, and followed for 12 months. Clinical, demographic and laboratorial data were collected. The impact of LDL, HbA1c and BMI on mortality was assessed using Cox regression and Kaplan-Meier curve, after adjustment for age, sex, functional class, ejection fraction and HF aetiology. A safety cut-off was established when any of these variables was deemed protective using ROC curve analysis. Pts were categorized according to CV risk classification.</p> <p><strong>Results: </strong>Two hundred twenty-four patients (71.68±13.45 years, 63.8% males) were included. Eighty-four (37.5%) pts had type 2 Diabetes, 39.7% had HF of ischemic aetiology and the median left ventricular ejection fraction was 34% IQR 25-49.5 (60.3% HFreF; 13.8% HFmrEF; 22.3% HFpEF). The median BMI was 25.4 IQR 23.1-30.5kg/m<sup>2</sup>, median LDL, 89.5 IQR 64-106mg/dL and median HbA1c, 6.4± IQR 5.6-6.8. The overall mortality rate during follow-up was 16.1%. According to the CV risk classification 39.7% pts were at very high risk and 19.6% pts at high risk.</p> <p>On multivariate analysis HbA1c (HR 1.5 IQR 1.1-1.9; p=0.007) and female sex (HR 9.453 IQR 2.4-37.2) were independent predictors of mortality; LDL (OR 1.05 IQR 1.022-1.075; p<0.001,) and BMI (OR 1.23 IQR 1.075-1.404; p=0.002) were independent protective factors. In the high and very high-risk population higher levels of LDL-C were still protective. (OR 1.05; IQR 1.02-1.06; p=0.013).</p> <p>In the study population, LDL-C of 88mg/dL was found to be the lower threshold associated with no increased risk of mortality (AUC 0.819; sensitivity 56.6%, specificity 100%); for high and very high CV risk pts a LDL-C safety cut-off of 84mg/dL can be used (AUC 0.815; sensitivity 59.3%). A BMI safety cut-off for mortality of 25.250 Kg/m2 was found (AUC 0.627; sensitivity 61.2%; specificity 58.3%). </p> <p><strong>Conclusion: </strong>This study supports the theory of the obesity and LDL paradox in HF, whereas, higher HbA1c is associated with higher mortality rate. Even though 2019 ESC dyslipidaemia guidelines suggest tighter LDL control for very high and high risk patients, the recommended cut-offs may be deleterious in HF patients as a level of LDL-Cholesterol below 88mg/gL in our cohort was associated with higher mortality.</p>
Slides
Video
Our mission: To reduce the burden of cardiovascular disease
Visit our site