The Effect Of Lipid-controling To The Prognosis Of Patients Of Heart Failure With Coronary Heart Disease

Objective:Investigate the lipid level, pharmacotherapy and prognosis of inpatients with chronic heart failure(CHF) who had coronary heart disease(CHD), and study the association between lipid, statin and prognosis. Expect to provide the reference for lipid-controling to the the patients of CHF who had CHD.Methods:2296 cases with CHD were collected in research from the Second Hospital of Tianjin Medical University from January 1993 to December 1995 and January 2005 to December 2007. Detailed information were recorded including basic data, lipid level, other biochemical indicators, echocardiogram result, complications, smoking and medication inhospital. Patients were categorized into groups of year, age, heart function, left ventricular ejection fraction(LVEF) and complications to analyze the lipid level.Investigate the cases of January 2005 to December 2007,and know the survival state and medication post-discharge to analyze the effect of lipid and statins to prognosis of CHF with CHD.Results:2296 cases were inrolled, among which there were 2090 patients with CHF. Investigate 1216 cases(NYHAⅠ～Ⅳ) for (30.2±9.6)months,222 patients were dead(accounting forl8.3%).①the lipid feature of CHF with CHD:to compare with mild heart failure and no CHF, the four kinds lipid of patients with moderate to severe heart failure were lower(P<0.05). Patients of CHF with CHD in this century had higher triglyceride (TG) and lower low-density lipoprotein cholesterol (LDL-C) than 90 age of last century(P<0.05). But there was no significant difference of total cholesterol(TC) and high-density lipoprotein(HDL-C) between the two groups. The lowest point of TG, TC, HDL-C and LDL-C appeared in the group of age more than 80 in male, while the patients of age less than 60 had higher TG, TC, LDL-C. The highest point of TC was in group age 50～59, but there was no difference of TG, HDL-C, LDL-C in female. Compare with pure CHD group, the CHF patients with hypertension had higher TG, and patient with atrial fibrillation had lower HDL-C and LDL-C(P<0.05).There were no significant differences between pure CHD group and the other groups of diabetes, anemia or renal failure.②the patient of heart failure with normal LVEF(HFNEF) had higher TG, TC and HDL-C than those with reduced LVEF (HFREF)(P<0.05), but there was no different between HFNEF and control group.③the fatality rate decreased along with raised HDL-C in mono-factor analyze (P=0.01).After adjustment for confused factors, the low and lower level of HDL-C were independent risk factor of prognosis, while TC, TG, LDL-C had no effect to prognosis. Additionally, age and heart function(NYHAⅢ～Ⅳ) were risk factor, and using ACEI was good for prognosis(P<0.01).④patients receiving statin had lower fatal rate(21.5%vsl5.8, P=0.010), but fatal rate was similar between statin use and no statin use patients in HFNEF and HFREF. After adjusting for other risk factors with Cox regression analysis, there were not differences of prognosis between statin use and no statin use in the patients of CHF with CHD.Conclusions:Patients of CHF with CHD are always with lipid disorders of lower level in serum lipid. So we can't treat CHF patient of CHD with common lipid-controlling, especially those whose lipid level was not abnormal. Statin using should be scientific and reasonable according to condition and heart function of patients, so that it can be beneficial to the most extent for patients with CHF.