Patient with heart failure with reduced ejection fraction (HFrEF) have more severe derangements in high-density lipoprotein particle (HDL-P) subfractions compared with patients with heart failure with preserved ejection fraction (HFpEF), according to results published in the Journal of the American College of Cardiology.

These results may help refine risk assessment for patients with HF.

The study included participants with HFrEF (n=782), participants with HFpEF (n=1004), and participants with no heart failure (HF) (n=4742) from the Catheterization Genetics biorepository of sequential patients undergoing cardiac catheterization. The researchers performed nuclear magnetic resonance-based lipoprotein profiling on frozen fasting plasma obtained from participants at the time of catheterization. They then used multivariable analysis of covariance to compare HDL-P subfractions across groups.

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The researchers found that mean HDL-P size was greater among participants with HFrEF compared with participants with HFpEF (P <.0001). In addition, both groups with HF had greater mean HDL-P size compared with patients with no HF (both P <.0001).

Concentrations of both small HDL-P and total HDL-P were less in participants with HFrEF compared with participants with HFpEF (P ≤.0002). Both HF groups had concentrations of small HDL-P and total HDL-P that were less compared with participants without HF (both P ≤.0002).

The results indicate that for participants with either HFrEF or HFpEF, total HDL-P and small HDL-P are inversely associated with time to adverse events. After adjusting for 14 clinical covariates, including high-density lipoprotein cholesterol content, coronary artery disease, and the inflammatory biomarker glycoprotein acetylation, these results remained significant and consistent.

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“Further investigation is needed to elucidate mechanisms underlying the observed associations and better understand the role of HDL-P in HF pathophysiology,” the researchers wrote.


Hunter WG, McGarrah RW III, Kelly JP, et al. High-density lipoprotein particle subfractions in heart failure with preserved or reduced ejection fraction. J Am Coll Cardiol. 2019;73(2):177-186.