Prognostic value of lipid parameters among patients with heart failure: A systematic review and meta-analysis

Aims: We sought to evaluate the prognostic value of different lipid parameters in patients with heart failure (HF). Methods and Results: Electronic databases including MEDLINE, Embase, CENTRAL, and Web of Science were searched to identify studies that reported the association of any of the four lipid parameters [total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides] with mortality among patients with HF. A random-effects model was used to estimate the association per 10 mg/dL increment. The QUIPS tool was used to assess the risk of bias. Fifty-two studies enrolling 93 286 patients were included. On univariable analysis, higher levels of the four lipid parameters were associated with lower mortality: TC [hazard ratio/odds ratio (HR/OR): 0.94; 95% confidence interval (CI): 0.93 to 0.96], HDL-C (HR/OR: 0.89; 95% CI: 0.80 to 0.99), LDL-C (HR/OR: 0.93; 95% CI: 0.90 to 0.97) and triglycerides (HR/OR: 0.95; 95% CI: 0.92 to 0.99). On multivariable analysis, lower levels of TC (HR/OR: 0.95; 95% CI: 0.93 to 0.97) and LDL-C (HR/OR: 0.94; 95% CI: 0.89 to 0.99) were associated with lower mortality. Conclusions: Higher levels of lipids parameters were associated with lower mortality in patients with HF. Lipid parameters may improve prognostication in predictive models for patients with HF. Because of the observational nature of included studies, no claims about the causal effect of changing lipid parameters can be made.