Exercise-Induced Increases in Oxidized Low-Density Lipoprotein Are Associated With Adverse Outcomes in Chronic Heart Failure

Jorde, Ulrich P.; Colombo, Paolo C.; Ahuja, Kartikya; Hudaihed, Alhakam; Onat, Duygu; Diaz, Thomas; Hirsh, David S.; Fisher, Edward A.; Tseng, Chi-Hong; Vittorio, Timothy J.

doi:10.1016/j.cardfail.2007.06.724

« Previous Next »Journal of Cardiac Failure
Volume 13, Issue 9 , Pages 759-764, November 2007

Exercise-Induced Increases in Oxidized Low-Density Lipoprotein Are Associated With Adverse Outcomes in Chronic Heart Failure

Ulrich P. Jorde, MD
- Division of Cardiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York
- Reprint requests: Ulrich P. Jorde, MD, Center for Advanced Cardiac Care, Columbia University Medical Center, 170 Ft. Washington Avenue, New York, NY 10032.
Paolo C. Colombo, MD
- Division of Cardiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York
Kartikya Ahuja, MD
- Leon Charney Division of Cardiology, New York University School of Medicine, New York, New York
Alhakam Hudaihed, MD
- Division of Cardiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York
Duygu Onat, PhD
- Division of Cardiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York
Thomas Diaz, MD
- Division of Cardiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York
David S. Hirsh, MD
- Leon Charney Division of Cardiology, New York University School of Medicine, New York, New York
Edward A. Fisher, MD
- Leon Charney Division of Cardiology, New York University School of Medicine, New York, New York
Chi-Hong Tseng, PhD
- Leon Charney Division of Cardiology, New York University School of Medicine, New York, New York
Timothy J. Vittorio, MD
- Division of Cardiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York

Received 20 February 2007; received in revised form 21 May 2007; accepted 18 June 2007.

Abstract

Background

Oxidative stress is an important pathophysiologic feature in chronic heart failure (CHF) and may in part result from the inability to counteract acute surges of circulating oxidant products. Oxidized low-density lipoprotein (oxLDL) is an emerging prognostic marker in CHF. Accordingly, we investigated the effect of exercise-induced oxidative stress on circulating levels of oxLDL and its association with clinical outcomes in CHF.

Methods and Results

Plasma levels of oxLDL and low-density lipoprotein cholesterol (LDL-c) were measured at rest and after maximal exercise in 48 subjects with CHF and 12 healthy controls. Subjects with CHF had a higher baseline oxLDL (77.7 ± 3.2 U/L vs 57.9 ± 5.0 U/L, P = .01) and a higher baseline oxLDL/LDL-c ratio (0.87 ± 0.04 vs 0.49 ± 0.04, P ≤ .001). Exercise induced an increase in oxLDL in subjects with CHF (77.7 ± 3.2 U/L to 85.3 ± 3.0 U/L, P ≤ .001) but not in controls (57.9 ± 5.0 to 61.4 ± 5.5, P = .17). In 39 subjects for whom follow-up data were available, an increase in oxLDL of more than 11.0 U/L was associated with an increased risk to meet a combined end point of death and need for ventricular assist device or heart transplant during a 19-month follow-up period (hazard ratio 8.6; 95% confidence interval 1.0–73.8, P = .05); this remained significant when adjusted for peak oxygen consumption, left ventricular ejection fraction, New York Heart Association class, sex, and age (hazard ratio 46.6, 95% confidence interval 1.5–1438.1, P = .02).

Conclusion

Plasma oxLDL and the oxLDL/LDL-c ratio are elevated in subjects with CHF. Whether assessment of oxLDL during maximal exercise allows early identification of subjects at highest risk for adverse outcomes should be systematically investigated.

Key Words: Exercise, heart failure, lipoproteins, oxidative stress