# Heart failure etiology and lipoprotein subfractions: Insight from the SMARTEX-HF study

## TL;DR

The study found that non-ischemic heart failure patients have higher levels of certain lipoproteins, which may affect heart structure and function.

## Contribution

The study reveals distinct lipoprotein profiles in non-ischemic versus ischemic heart failure patients and their associations with heart structure.

## Key findings

- Non-ischemic heart failure patients had higher levels of 48 lipoproteins, including LDL, VLDL, and HDL subfractions.
- Triglyceride content in some VLDL and LDL subfractions was weakly linked to left ventricular structure and function.
- Statin treatment and heart failure etiology explained significant variability in cholesterol and ApoB levels.

## Abstract

We investigated the relationship between heart failure etiology and lipoprotein subfractions, and to explore their associations with left ventricular dimension and function in heart failure with reduced ejection fraction (HFrEF) patients.

Cross-sectional investigation of serum lipoprotein subfractions from 205 HFrEF patients in the SMARTEX heart failure study. Serum levels of triglycerides, cholesterol, free cholesterol, phospholipids, lipoproteins (Apolipoproteins; A-1, A-2, and B), very-low-density (VLDL), intermediate-density (IDL), low-density (LDL), and high-density lipoprotein (HDL) were determined using 1H-Nuclear Magnetic Resonance spectroscopy.

Stable HFrEF patients [left ventricular ejection fraction (LVEF) ≤ 35%, NYHA class II-III], with ischemic (ICM, n = 119) or non-ischemic (NICM, n = 86) cardiomyopathy were studied. NICM patients had higher levels of 48 lipoproteins compared to ICM patients, including 29 LDL, 13 VLDL, and 6 HDL subfractions [p <0.05]. NICM patients had 22% higher cholesterol and 27% higher remnant cholesterol levels, with 24% more atherogenic ApoB containing subfractions (VLDL, IDL, LDL) (p <0.05). Heart failure etiology and statin treatment explained 23–24% of the variability in cholesterol, free cholesterol, and ApoB (p <0.001). Triglyceride content in some VLDL and LDL subfractions was weakly associated with left ventricular end-diastolic volume, end-diastolic diameter, ejection fraction, and S’.

NICM patients had the highest atherosclerotic lipoprotein burden, attributed to elevated ApoB particles and partly due to less statin treatment. The triglyceride content of some VLDL and LDL subfractions was weakly associated with left ventricular structure and function. However, further research is needed to determine their prognostic significance before implementation into strategies for prevention and treatment.

Trail Registration: ClinicalTrial.gov database (NCT00917046)