• Saira Rafaqat Department of Zoology (Molecular Physiology), Lahore College for Women University, Lahore, Punjab
  • Sana Rafaqat Department of Biotechnology (Human Genetics), Lahore College for Women University, Lahore, Punjab
  • Aleksandra Klisić Primary Health Care Center, University of Montenegro-Faculty of Medicine, Podgorica, Montenegro




heart failure, lipid profile, atherosclerosis


A complicated clinical disease known as heart failure (HF) comes on by anatomical or functional anomalies in the heart that compromise blood flow. This review article presents a comprehensive examination of the role of lipid profiles in the HF. It specifically focuses on the serum levels of traditional lipid parameters, such as total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) in the development and progression of the HF. To conduct this review, several databases such as Google Scholar, PubMed, and Science Direct were utilized. Specific keywords used in the search include “heart failure”, “lipid profile”, “triglycerides”, “total cholesterol”, “high-density lipoprotein cholesterol”, and “low-density lipoprotein cholesterol”. The language for clinical investigations included in this review were limited to those set to English. The findings suggest that lower levels of TG may be associated with elevated pulmonary artery pressure, tricuspid regurgitation, and increased dimensions of the right side of the heart. These associations indicate impaired liver function due to right-sided HF in the chronic HF patients. Dysfunctional HDL-C is believed to contribute to the occurrence and advancement of HF. Additionally, serum TC levels have been identified as a potential prognostic factor in individuals with advanced HF. On the other hand, lower LDL-C levels seem to indicate worse prognosis for HF patients.  However, further research is required to determine the precise mechanisms by which these lipid profiles influence the development and progression of the HF.


Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res 2023;118(17):3272-3287.

Wadström BN, Pedersen KM, Wulff AB, Nordestgaard BG. Elevated remnant cholesterol, plasma triglycerides, and cardiovascular and non-cardiovascular mortality. Eur Heart J 2023;44(16):1432-1445.

Klisic A, Kotur-Stevuljevic J, Kavaric N, Matic M. Relationship between cystatin C, retinol-binding protein 4 and Framingham risk score in healthy postmenopausal women. Arch Iran Med 2016;19(12):845-851.

Klisic A, Kavaric N, Ninic A. Are liver function biomarkers independently associated with Framingham risk score in female population? Srp Arch Celok Lek 2020;148(7-8):423-429.

Klisić A, Kavarić N, Bjelaković B, Jovanović M, Zvrko E, Škerović V, Ninić A, Šćepanović A. Cardiovascular risk assessed by Reynolds risk score in relation to waist circumference in apparently healthy middle-aged population in Montenegro. Acta Clin Croat 2018;57:22-30.

Bjelakovic B, Stefanutti C, Vukovic V, Kavaric N, Saranac Lj, Lukic S, Klisic A, Stankovic S, Jovic M, Prijic S, Bjelakovic M, Banach M. Lipid profile and left ventricular geometry pattern in obese children. Lipids Health Dis 2020;19(1):109.

Klisic A, Kavaric N, Soldatovic I, Bjelakovic B, Kotur-Stevuljevic J. Relationship between cardiovascular risk score and traditional and nontraditional cardiometabolic parameters in obese adolescent girls. J Med Biochem 2016;35(3):282-292.

Wittenbecher C, Eichelmann F, Toledo E, Guasch-Ferré M, Ruiz-Canela M, Li J, Arós F, Lee CH, Liang L, Salas-Salvadó J, Clish CB, Schulze MB, Martínez-González MÁ, Hu FB. Lipid Profiles and Heart Failure Risk: Results From Two Prospective Studies. Circ Res 2021;128(3):309-320.

Choi SS, Diehl AM. Hepatic triglyceride synthesis and nonalcoholic fatty liver disease. Curr Opin Lipidol 2008;19(3):295- 300.

Halldin AK, Lissner L, Lernfelt B, Björkelund C. Cholesterol and triglyceride levels in midlife and risk of heart failure in women, a longitudinal study: the prospective population study of women in Gothenburg. BMJ Open 2020;10(6):e036709.

Rauchhaus M, Coats AJ, Anker SD. The endotoxin-lipoprotein hypothesis. Lancet 2000;356(9233):930-933.

Freitas HF, Barbosa EA, Rosa FH, Lima AC, Mansur AJ. Association of HDL cholesterol and triglycerides with mortality in patients with heart failure. Braz J Med Biol Res 2009;42(5):420-425.

Kozdag G, Ertas G, Emre E, Akay Y, Celikyurt U, Sahin T, Gorur G, Karauzum K, Yilmaz I, Ural D, Sarsekeyeva M. Low serum triglyceride levels as predictors of cardiac death in heart failure patients. Tex Heart Inst J 2013;40(5):521-528.

Pillarisetti J, Nath J, Berenbom L, Lakkireddy D. Cardiac cirrhosis: a rare manifestation of an uncorrected primum atrial septal defect. J Cardiovasc Med (Hagerstown) 2010;11(9): 689-691.

Kato T, Niizuma S, Inuzuka Y, Kawashima T, Okuda J, Kawamoto A, et al. Analysis of liver metabolism in a rat model of heart failure. Int J Cardiol 2012;161(3):130-136.

Araújo JP, Friões F, Azevedo A, Lourenço P, Rocha-Gonçalves F, Ferreira A, Bettencourt P. Cholesterol--a marker of nutritional status in mild to moderate heart failure. Int J Cardiol 2008;129(1):65-68.

Velagaleti RS, Massaro J, Vasan RS, Robins SJ, Kannel WB, Levy D. Relations of lipid concentrations to heart failure incidence: the Framingham Heart Study. Circulation 2009;120(23):2345-2351.

Mehra MR, Uber PA, Lavie CJ, Milani RV, Park MH, Ventura HO. High-density lipoprotein cholesterol levels and prognosis in advanced heart failure. J Heart Lung Transplant. 2009;28(9):876-880.

Iwaoka M, Obata JE, Abe M, Nakamura T, Kitta Y, Kodama Y, Kawabata K, Takano H, Fujioka D, Saito Y, Kobayashi T, Hasebe H, Kugiyama K. Association of low serum levels of apolipoprotein A-I with adverse outcomes in patients with nonischemic heart failure. J Card Fail 2007;13(4):247-253.

Muthuramu I, Amin R, Aboumsallem JP, Mishra M, Robinson EL, De Geest B. Hepatocyte-Specific SR-BI Gene Transfer Corrects Cardiac Dysfunction in Scarb1-Deficient Mice and Improves Pressure Overload-Induced Cardiomyopathy. Arterioscler Thromb Vasc Biol 2018;38(9):2028-2040.

Amin R, Muthuramu I, Aboumsallem JP, Mishra M, Jacobs F, De Geest B. Selective HDL-Raising Human Apo A-I Gene Therapy Counteracts Cardiac Hypertrophy, Reduces Myocardial Fibrosis, and Improves Cardiac Function in Mice with Chronic Pressure Overload. Int J Mol Sci 2017;18(9):2012.

Rauchhaus M, Clark AL, Doehner W, Davos C, Bolger A, Sharma R, Coats AJ, Anker SD. The relationship between cholesterol and survival in patients with chronic heart failure. J Am Coll Cardiol 2003;42(11):1933-1940.

Diab A, Valenzuela Ripoll C, Guo Z, Javaheri A. HDL Composition, Heart Failure, and Its Comorbidities. Front Cardiovasc Med 2022;9:846990.

Emmens JE, Jia C, Ng LL, van Veldhuisen DJ, Dickstein K, Anker SD, Lang CC, Filippatos G, Cleland JGF, Metra M, Voors AA, de Boer RA, Tietge UJF. Impaired High-Density Lipoprotein Function in Patients With Heart Failure. J Am Heart Assoc 2021;10(9):e019123.

Velavan P, Huan Loh P, Clark A, Cleland JG. The cholesterol paradox in heart failure. Congest Heart Fail 2007;13(6):336-341.

Walldius G, Jungner I, Holme I, Aastveit AH, Kolar W, Steiner E. High apolipoprotein B, low apolipoprotein A-I, and improvement inthe prediction of fatal myocardial infarction (AMORIS study): aprospective study. Lancet 2001;358:2026-2033.

Steer P, Hulthe J, Millgård J, et al. Endothelial vasodilatory functionis predicted by circulating apolipoprotein B and HDL in healthyhumans. Lipids 2002;37:1135– 1140.

Ingelsson E, Ärnlöv J, Sundström J, Zethelius B, Vessby B, Lind L. Novel metabolic risk factors for heart failure. J Am Coll Cardiol 2005;46(11):2054-2060.

Rauchhaus M, Koloczek V, Volk HD, Kemp M, Niebauer J, Francis DP, Coats AJ, Anker SD. Inflammatory cytokines and the possible immunological role for lipoproteins in chronic heart failure. Int J Cardiol 2000;76(2-3):125-133.

Miura S, Saku K. Effects of statin and lipoprotein metabolism in heart failure. J Cardiol 2010;55(3):287-290.

Kosmas CE, Alkhawam H, El-Hunjul M, Wagman G, Kahn MR, Grady KM, Vittorio TJ. Statin-mediated low-density lipoprotein lowering in chronic congestive heart failure. Am J Med Sci 2014;347(1):14-22.

Charach G, George J, Roth A, Rogowski O, Wexler D, Sheps D, Grosskopf I, Weintraub M, Keren G, Rubinstein A. Baseline low-density lipoprotein cholesterol levels and outcome in patients with heart failure. Am J Cardiol 2010;105(1):100-104.

Horwich TB, Hamilton MA, MacLellan WR, Fonarow GC. Low serum total cholesterol is associated with marked increase in mortality in advanced heart failure. J Card Fail 2002;8(4):216-224.

Rauchhaus M, Clark AL, Doehner W, Davos C, Bolger A, Sharma R, Coats AJ, Anker SD. The relationship between cholesterol and survival in patients with chronic heart failure. J Am Coll Cardiol 2003;42(11):1933-1940.

Kahn MR, Kosmas CE, Wagman G, Serrao GW, Fallahi A, Grady KM, Vittorio TJ. Low-density lipoprotein levels in patients with acute heart failure. Congest Heart Fail 2013;19(2):85-91.






Review Articles