路透社健康专栏9月20日从纽约报道：根据“美国心脏病杂志”九月刊报道：相对而言，总胆固醇（TC）水平较高（200 mg/dL）的心衰患者比总胆固醇水平较低（140 mg/dL）的心衰患者存活率要高。
通常认为升高TC水平会降低冠心病患者的存活率。但该研究主研究员，来自犹他州盐湖城基督教后期圣徒医院的Heidi T. May在评论该研究结果说“研究结论不是凭直觉得出的”。
因为70％的心衰患者会出现炎症，而且炎症情况与TC水平较低有关。因此May和她的同事做了个假设：TC水平低与心衰症低生存率相关。
从1993年到2003年，研究人员用10年时间，从各个合作研究点筛选了1646名心衰症患者参与试验，测定其受试者TC水平及其存活情况。
根据受试者TC水平，研究人员将受试者分为4个小组：140 mg/dL以下的为组1， 141-167 mg/dL的为组2，168-200 mg/dL的为组3，大于200 mg/dL的为组4。
受试者平均年龄为65.5岁， 其中65％为男性，65％患有冠状动脉疾病。受试者平均射血分数为40％以下，研究者对受试者的平均跟踪时间为2.4年。
组3的受试者死亡率与组1受试者的死亡率之比为0.66，或者说组3的死亡率比组1下降34％左右。组1和组4的受试者死亡率相当。
对于C-反应蛋白水平来说，组3水平最低，组1最高。表明组3炎症发生几率最低。（近年来，随着对脑梗死损伤机理研究的深入，疾病早期过程的炎症反应是动脉粥样硬化性心脑血管病进展的重要机制之一。C-反应蛋白（CRP）是一种典型的急性期蛋白，CRP的合成与致炎症性细胞因子有着密切的关系，其水平升高是炎症反应的一个重要生化指标，它与缺血性心脑血管疾病的发生发展的关系日益受到重视。
但是，“研究表明高胆固醇水平也会对心脏病患者的存活产生负面的影响，”May接受路透社健康专栏采访时说，“因此建议在治疗心衰症时要兼顾患者的胆固醇水平和炎症情况。”
美国心脏病杂志2006;98:653-658.
NEW YORK (Reuters Health) Sept 20 - A total cholesterol (TC) level approaching 200 mg/dL is associated with higher survival in patients with heart failure than levels below 140 mg/dL, according to a report in the September issue of the American Journal of Cardiology.
"Nonintuitive" is how principal investigator Heidi T. May of Latter Day Saints Hospital in Salt Lake City, Utah, describes the findings, since elevated TC is such a significant risk factor for coronary heart disease.
Because inflammation is present in approximately 70% of patients with heart failure, and inflammation is associated with lower TC, May and colleagues hypothesized that a lower TC is associated with poorer survival in heart failure.
The researchers evaluated TC levels and survival in 1,646 patients with heart failure selected from the Intermountain Collaborative Study Registry, a ten-year database spanning the years 1993-2003.
Total cholesterol levels were divided into quartiles, with quartile 1 having TC levels of 140 mg/dL and below, quartile 2 had TC levels of 141-167 mg/dL, quartile 3 had TC levels between 1168-200 mg/dL and those in the highest quartile had TC levels above 200 mg/dL.
Mean age of the patients was 65.5 years, 65% were men and 65% had coronary artery disease. Mean ejection fraction was 40% or less. Mean follow-up was 2.4 years
The hazard ratio for death for those in quartile 3 compared with quartile 1 was 0.66, or a mortality risk reduction of 34%. Mortality risk for quartile 1 and quartile 4 was similar.
Patients in quartile 3 had the lowest mean and median C-reactive protein levels, indicating the lowest levels of inflammation of the four groups. The highest mean and median C-reactive protein levels occurred in patients in quartile 1.
However, "there is a point at which high cholesterol adversely affects survival," May told Reuters Health. Thus, she concluded, "the findings suggest that both cholesterol and inflammation need to be adequately treated in patients with heart failure."
Am J Cardiol 2006;98:653-658.
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