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Observational Study
. 2024 Jun;11(3):1758-1766.
doi: 10.1002/ehf2.14734. Epub 2024 Mar 8.

Low-density lipoprotein cholesterol, erythrocyte, and platelet in heart failure with preserved ejection fraction

Masamichi Yano  1 , Masami Nishino  1 , Shodai Kawanami  1 , Kohei Ukita  1 , Akito Kawamura  1 , Koji Yasumoto  1 , Masaki Tsuda  1 , Naotaka Okamoto  1 , Yasuharu Matsunaga-Lee  1 , Yasuyuki Egami  1 , Takahisa Yamada  2 , Yoshio Yasumura  3 , Masahiro Seo  2 , Takaharu Hayashi  4 , Akito Nakagawa  3   5 , Yusuke Nakagawa  6 , Shunsuke Tamaki  7   8 , Yohei Sotomi  9 , Daisaku Nakatani  9 , Shungo Hikoso  9   10 , Yasushi Sakata  9 ; Osaka CardioVascular Conference (OCVC)‐Heart Failure Investigators
Affiliations
Observational Study

Low-density lipoprotein cholesterol, erythrocyte, and platelet in heart failure with preserved ejection fraction

Masamichi Yano et al. ESC Heart Fail. 2024 Jun.

Abstract

Aims: Low-density lipoprotein cholesterol (LDL-C), anaemia and low platelets have been associated with worse clinical outcomes in heart failure patients. We investigated the relationship between the combination of these three components and clinical outcome in patients with heart failure with preserved ejection fraction (HFpEF).

Methods and results: We examined the data of 1021 patients with HFpEF hospitalized with acute decompensated heart failure (HF) from the PURSUIT-HFpEF registry, a prospective, multicenter observational study. The enrolled patients were classified into four groups by an LEP (LDL-C, Erythrocyte, and Platelet) score of 0 to 3 points, with 1 point each for LDL-C, erythrocyte and platelet values less than the cut-off values as calculated by receiver operating characteristic curve analysis. The endpoint, a composite of all-cause death and HF readmission, was evaluated among the four groups. Median follow-up duration was 579 [300, 978] days. Risk of the composite endpoint significantly differed among the four groups (P < 0.001). Kaplan-Meier analysis showed that the groups with an LEP score of 2 had higher risk of the composite endpoint than those with an LEP score of 0 or 1 (P < 0.001, and P = 0.013, respectively), while those with an LEP score of 3 had higher risk than those with an LEP score of 0, 1 or 2 (P < 0.001, P < 0.001 and P = 0.020, respectively). Cox proportional hazards analysis showed that an LEP score of 3 was significantly associated with the composite endpoint (P = 0.030). Kaplan-Meier analysis showed that risk of the composite of all-cause death and HF readmission was significantly higher in low LDL values (less than the cut-off values as calculated by receiver operating characteristic curve analysis) patients with statin use than in those without statin use (log rank P = 0.002).

Conclusions: LEP score, which comprehensively reflects extra-cardiac co-morbidities, is significantly associated with clinical outcomes in HFpEF patients.

Keywords: Erythrocyte; Heart failure with preserved ejection fraction; Low‐density lipoprotein cholesterol; Platelet; Prognosis.

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Conflict of interest statement

Y. Sotomi has received grants from Roche Diagnostics, FUJIFILM Toyama Chemical, TOA EIYO, Bristol‐Myers Squibb, Biosense Webster, Abbott Medical Japan, and NIPRO, and personal fees from Abiomed, AstraZeneca, Amgen Astellas BioPharma, Biosensors, Boehringer Ingelheim, Bristole‐Myers Squibb, Abbott Medical Japan, Boston Scientific Japan, Bayer, Daiichi Sankyo, Novartis, TERUMO, Medtronic, and Pfizer Pharmaceuticals.

Daisaku Nakatani has received honoraria from Roche Diagnostics. Daisaku Nakatani has received honoraria from Roche Diagnostics. Shungo Hikoso has received personal fees from Daiichi Sankyo Company, Bayer, Astellas Pharma, Pfizer Pharmaceuticals and Boehringer Ingelheim Japan, and grants from Roche Diagnostics, FUJIFILM Toyama Chemical and Actelion Pharmaceuticals. Yasushi Sakata has received personal fees from Otsuka Pharmaceutical, Ono Pharmaceutical, Daiichi Sankyo Company, Mitsubishi Tanabe Pharma Corporation and Actelion Pharmaceuticals, and grants from Roche Diagnostic, FUJIFILM Toyama Chemical, Abbott Medical, Japan, Otsuka Pharmaceutical, Daiichi Sankyo Company, Mitsubishi Tanabe Pharma Corporation and Biotronik. The other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Study flowchart. LDL‐C, low density lipoprotein cholesterol; ROC, receiver operating characteristics.
Figure 2
Figure 2
Kaplan–Meier analysis of the composite of all‐cause death and HF readmission among the four groups, according to LEP score. HF, heart failure.
Figure 3
Figure 3
Kaplan–Meier analysis of the composite of all‐cause death and HF readmission in patients with LDL‐C < 76 mg/dL with and without statin use. HF, heart failure; LDL‐C, low density lipoprotein cholesterol.
Figure 4
Figure 4
Possible mechanism of the impact of the three components on HFpEF. HF, heart failure; HFpEF, heart failure with preserved ejection fraction; LDL‐C, low density lipoprotein cholesterol; RAAS, renin‐angiotensin‐aldosterone system.
See this image and copyright information in PMC

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