Background: Hyperlipidemia is a recognized risk factor for incident acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF), and no such documented association with pneumonia. However, the influence of hyperlipidemia on long-term mortality after AMI, HF, or pneumonia has not yet been fully understood. The objectives are to estimate the effect of hyperlipidemia and its interaction with other comorbid conditions in influencing the long-term mortality after hospitalization for acute myocardial infarction (AMI), heart failure (HF), and pneumonia.

Methods: A retrospective study of hospitalized patients for AMI and ADHF at a large academic center in the United States between 1996 and 2015.

Results: We identified 13,680 patients with AMI (age 68±14 year, men 66%, and Whites 88%), 9,717 patients with ADHF (age 73±14Y, men 58%, and whites 87%), and 8,553 patients with pneumonia ((age 69±17 year, men 53%, and Whites 88%). Hyperlipidemia (HLP) was found in 47%, 31%, and 27% of patients with AMI, ADHF, and pneumonia respectively. After adjustment to demographics, clinical characteristics, and other competing comorbid conditions, hyperlipidemia was associated with a lower risk of death after hospitalization for AMI (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.61-0.69, P <0.0001), ADHF (HR 0.77, 95% CI 0.72-0.82, P <0.0001), and pneumonia (HR 0.73, 95% CI 0.73-0.79, P <0.0001) over a median follow of 6, 3, and 4 years respectively. As shown in accompanying figure, HLP reduced the magnitude of hazard ratios (HR) for mortality from other comorbid conditions including cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, stroke, coronary artery disease, and heart failure.

Conclusions: After hospitalization for AMI, ADHF, and pneumonia, the risk of long-term mortality was lower among patients with a concomitant diagnosis of HLP compared to those without HLP. When clustered with other comorbidities, HLP attenuated the magnitude of association between these comorbidities and long-term mortality.

IMAGE 1: Multi variable Cox proportional regression analysis showing hazards ratio for long-term mortality among patients with acute myocardial infarction, acute decompensated heart failure, and pneumonia