{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:45:28Z","timestamp":1786977928542,"version":"build-2736575974"},"reference-count":57,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dyslipidaemia is among the major risk factors for atherosclerotic cardiovascular disease. Paradoxically, higher cholesterol levels are associated with better survival in heart failure (HF) of any aetiology. Because cholesterol is an integral component of skeletal muscle structure, one possible explanation involves the interplay between lipid metabolism and skeletal muscle health. Using data from the Studies Investigating Comorbidities Aggravating Heart Failure, we investigated whether an association exists between low\u2010density lipoprotein cholesterol (LDL\u2010C) levels and all\u2010cause mortality in patients with chronic HF in the context of skeletal muscle mass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 241 patients with chronic HF (68\u2009\u00b1\u200911\u2009years, 80% male, left ventricular ejection fraction 39%\u2009\u00b1\u200913%) were enrolled. LDL\u2010C levels were divided into low and high based on the median value (93\u2009mg\/dL). The appendicular skeletal muscle mass index (ASMI) was assessed using a dual\u2010energy X\u2010ray absorptiometry scan and divided into high and low based on the sex\u2010specific median value (men\u2009=\u20097.97\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , women\u2009=\u20096.87\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). Patients were divided into four groups based on median LDL\u2010C levels and ASMI values.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a median follow\u2010up of 6.3\u2009years, 95 patients (39%) died. There were differences in mortality between the four groups, with the highest mortality in patients with low LDL\u2010C levels and low ASMI and the lowest mortality in patients with high LDL\u2010C levels and high ASMI (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002, by log\u2010rank). The low LDL\u2010C group had higher mortality compared with the high LDL\u2010C group (46% vs. 33%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01, by log\u2010rank). Multivariate Cox proportional hazard analysis confirmed the association between the low LDL\u2010C group and higher mortality (adjusted hazard ratio [aHR] 1.65 [1.00\u20132.72],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). This prognostic impact of low LDL\u2010C appeared greater in the low ASMI group than in the high ASMI group (56% vs. 37%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01, and 36% vs. 28%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.28, by log\u2010rank:\n                      <jats:italic>p<\/jats:italic>\n                      for interaction\u2009=\u20090.47). In the low ASMI group, lower LDL\u2010C levels were predictors of mortality in multivariate Cox proportional hazard models (aHR 1.46\u20131.48 per 1 SD decrease in LDL\u2010C, all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with chronic HF, lower LDL\u2010C levels were associated with higher mortality, especially in the low ASMI group. These findings suggest that low cholesterol levels may exacerbate skeletal muscle loss, potentially creating a vicious cycle that worsens patient outcomes. Lipid\u2010modulating strategies could help mitigate muscle wasting in HF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.70168","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T12:40:01Z","timestamp":1768567201000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Skeletal Muscle Mass Modifies the Prognostic Impact of LDL Cholesterol in Chronic Heart Failure"],"prefix":"10.1002","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0724-7842","authenticated-orcid":false,"given":"Ryosuke","family":"Sato","sequence":"first","affiliation":[{"name":"Department of Cardiology and Pneumology University Medical Center G\u00f6ttingen  G\u00f6ttingen Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Garfias\u2010Veitl","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology University Medical Center G\u00f6ttingen  G\u00f6ttingen Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony  G\u00f6ttingen Germany"},{"name":"Department of Medical Statistics University Medical Center G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guglielmo","family":"Fibbi","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology University Medical Center G\u00f6ttingen  G\u00f6ttingen Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony  G\u00f6ttingen Germany"},{"name":"Department of Geriatrics University Medical Center G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirela","family":"Vatic","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology University Medical Center G\u00f6ttingen  G\u00f6ttingen Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Doehner","sequence":"additional","affiliation":[{"name":"Berlin Institute of Health Center for Regenerative Therapies (BCRT) Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin  Berlin Germany"},{"name":"Department of Cardiology (Virchow\u2010Klinikum) Charit\u00e9 University Medical Center Berlin  Berlin Germany"},{"name":"German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charit\u00e9 Universit\u00e4tsmedizin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan\u00a0D.","family":"Anker","sequence":"additional","affiliation":[{"name":"German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charit\u00e9 Universit\u00e4tsmedizin  Berlin Germany"},{"name":"Department of Cardiology (CVK) of German Heart Center Charit\u00e9  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9818-042X","authenticated-orcid":false,"given":"Stephan","family":"von Haehling","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology University Medical Center G\u00f6ttingen  G\u00f6ttingen Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"World Health 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