TY - JOUR
T1 - Heart failure etiology and lipoprotein subfractions
T2 - Insight from the SMARTEX-HF study
AU - Karlsen, Trine
AU - Vesterbekkmo, Elisabeth K.
AU - Hole, Torstein
AU - Larsen, Alf Inge
AU - Valborgland, Torstein
AU - Braaten, Tonje
AU - Bathen, Tone F.
AU - Beckers, Paul
AU - Delagardelle, Charles
AU - Feiereisen, Patrick
AU - Craenenbroeck, Emeline Van
AU - Linke, Axel
AU - Prescott, Eva
AU - Halle, Martin
AU - Ellingsen, Øyvind
AU - Dalen, Håvard
N1 - Publisher Copyright:
© 2026 The Author(s)
PY - 2026/4
Y1 - 2026/4
N2 - Background: 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. Methods: 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. Results: 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’. Conclusions: 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
AB - Background: 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. Methods: 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. Results: 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’. Conclusions: 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
KW - Cardiomyopathy
KW - HDL
KW - Heart failure
KW - IDL
KW - LDL
KW - VLDL
UR - https://www.scopus.com/pages/publications/105030096269
U2 - 10.1016/j.ijcha.2026.101888
DO - 10.1016/j.ijcha.2026.101888
M3 - Journal article
C2 - 41736908
AN - SCOPUS:105030096269
SN - 2352-9067
VL - 63
JO - IJC Heart and Vasculature
JF - IJC Heart and Vasculature
M1 - 101888
ER -