That is, low cholesterol levels have been shown to be independently associated with increased mortality and higher cholesterol levels with improved survival. In pa- tients with chronic HF, this inverse relationship has been demonstrated in patients with HF of ischemic and non- ischemic origin with a cutoff for total cholesterol at 190 This inverse relationship also held true in a large cohort of patients admitted with acute It is currently unclear whether low cholesterol levels play a causative role in the worse out- come of patients with HF or whether low cholesterol lev- els merely reflect an advanced disease state. Moreover, the question of whether there is a difference between intrinsically low cholesterol and low cholesterol as a re- sult of treatment remains unanswered. Treatment of Hyperlipidemia in HF for the Indication of HF Alone Numerous retrospective analyses and small, prospec- tive trials have demonstrated the beneficial effects of statins in patients with HF with respect to mortality and Furthermore, retrospective analy- ses of trials in patients with coronary artery disease but without a history of HF demonstrated a reduction in the risk of development of HF and HF hospitalizations in patients taking statins.272 However, 2 large, prospec- tive, randomized trials failed to confirm these beneficial effects of statins in patients with established HF. CORO- NA (Controlled Rosuvastatin Multinational Trial in Heart Failure) randomized 5011 patients (age 60 years) with NYHA class II to IV ischemic HF to 10 mg rosuvastatin versus placebo. In this trial, treatment with rosuvastatin did not confer a significant benefit with respect to the primary end point, a composite of death resulting from cardiovascular causes, nonfatal MI, or nonfatal stroke, or several secondary end points, including all-cause mortality, coronary events, and worsening HF, despite a significant decrease in low-density lipoprotein choles- terol and C-reactive protein. 