Impaired High-Density Lipoprotein Anti-Oxidative Function Is Associated With Outcome in Patients With Chronic Heart Failure

Background--oxidative stress is mechanistically linked to the pathogenesis of chronic heart failure (chf). antioxidative functions of high-density lipoprotein (hdl) particles have been found impaired in patients with ischemic cardiomyopathy; however,the impact of antioxidative hdl capacities on clinical outcome in chf patients is unknown. we therefore investigated the predictive value of antioxidative hdl function on mortality in a representative cohort of patients with chf. methods and results--we prospectively enrolled 320 consecutive patients admitted to our outpatient department for heart failure and determined antioxidative hdl function using the hdl oxidative index (hoi). during a median follow-up time of 2.8 (iqr: 1.8-4.9) years,88 (27.5%) patients reached the combined cardiovascular endpoint defined as the combination of death due to cardiovascular events and heart transplantation. an hoi ≥1 was significantly associated with survival free of cardiovascular events in cox regression analysis with a hazard ratio (hr) of 2.28 (95% ci 1.48-3.51,p<0.001). this association remained significant after comprehensive multivariable adjustment for potential confounders with an adjusted hr of 1.83 (95% ci 1.1-2.92,p=0.012). determination of hoi significantly enhanced risk prediction beyond that achievable with n-terminal pro-b-type natriuretic peptide indicated by improvements in net reclassification index (32.4%,p=0.009) and integrated discrimination improvement (1.4%,p=0.04). conclusions--impaired antioxidative hdl function represents a strong and independent predictor of mortality in patients with chf. implementation of hoi leads to a substantial improvement of risk prediction in patients with chf. © 2016 the authors.