Gavin Ng1, Elaine Boey1, Chris Frampton2, Arthur Mark Richards1,3, Tiong-Cheng Yeo1, Chi-Hang Lee4,5. 1. Department of Cardiology, National University Heart Centre Singapore, 1E, Kent Ridge Road, Singapore, 119228, Singapore. 2. Department of Medicine, University of Otago, Christchurch, New Zealand. 3. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 4. Department of Cardiology, National University Heart Centre Singapore, 1E, Kent Ridge Road, Singapore, 119228, Singapore. mdclchr@nus.edu.sg. 5. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. mdclchr@nus.edu.sg.
Abstract
PURPOSE: Visit-to-visit variability in low-density lipoprotein-cholesterol (LDL-C) was found to be a novel predictor of adverse cardiac events. Obstructive sleep apnea (OSA), an emerging cardiovascular risk factor, is characterized by sympathetic activation and increased oxidative stress which are regulators of LDL-C metabolism. We hypothesized that OSA was associated with LDL-C variability. METHODS: We prospectively recruited 190 patients with coronary artery disease for an overnight sleep study. Statin was prescribed upon discharge for 186 patients. Serum LDL-C levels were measured at clinic every 3 to 6 months. Severity of OSA (on the basis of apnea-hypopnea index (AHI)) was correlated with visit-to-visit LDL-C variability (on the basis of variation independent of mean (VIM)) in outpatient clinic. RESULTS: The mean AHI was 21.9 ± 18.9. Using an AHI cut-off of 5-14.9, 15-29.9, and ≥30, the prevalence of mild, moderate, and severe OSA was 26.3, 18.9, and 27.4 %, respectively. After 53.2 ± 25.3 months, LDL-C was recorded over 8.1 ± 4.2 measurements. VIM positively correlated with AHI (Pearson's r = 0.183, p = 0.016), but not body mass index, baseline and mean follow-up LDL-C levels, and number of LDL-C measurements. In multiple linear regression analysis, AHI remained an independent predictor of VIM after adjusting for diabetes mellitus and hyperlipidemia. A 10-unit rise in AHI led to a 3.8 % increase in VIM (95 % CI 0.1 to 7.4 %; p = 0.044). CONCLUSION: This is the first study to show the independent correlation between OSA severity and visit-to-visit LDL-C variability. Our finding contributes to the understanding of the vasculopathic effects of OSA.
PURPOSE: Visit-to-visit variability in low-density lipoprotein-cholesterol (LDL-C) was found to be a novel predictor of adverse cardiac events. Obstructive sleep apnea (OSA), an emerging cardiovascular risk factor, is characterized by sympathetic activation and increased oxidative stress which are regulators of LDL-C metabolism. We hypothesized that OSA was associated with LDL-C variability. METHODS: We prospectively recruited 190 patients with coronary artery disease for an overnight sleep study. Statin was prescribed upon discharge for 186 patients. Serum LDL-C levels were measured at clinic every 3 to 6 months. Severity of OSA (on the basis of apnea-hypopnea index (AHI)) was correlated with visit-to-visit LDL-C variability (on the basis of variation independent of mean (VIM)) in outpatient clinic. RESULTS: The mean AHI was 21.9 ± 18.9. Using an AHI cut-off of 5-14.9, 15-29.9, and ≥30, the prevalence of mild, moderate, and severe OSA was 26.3, 18.9, and 27.4 %, respectively. After 53.2 ± 25.3 months, LDL-C was recorded over 8.1 ± 4.2 measurements. VIM positively correlated with AHI (Pearson's r = 0.183, p = 0.016), but not body mass index, baseline and mean follow-up LDL-C levels, and number of LDL-C measurements. In multiple linear regression analysis, AHI remained an independent predictor of VIM after adjusting for diabetes mellitus and hyperlipidemia. A 10-unit rise in AHI led to a 3.8 % increase in VIM (95 % CI 0.1 to 7.4 %; p = 0.044). CONCLUSION: This is the first study to show the independent correlation between OSA severity and visit-to-visit LDL-C variability. Our finding contributes to the understanding of the vasculopathic effects of OSA.
Authors: Virend K Somers; David P White; Raouf Amin; William T Abraham; Fernando Costa; Antonio Culebras; Stephen Daniels; John S Floras; Carl E Hunt; Lyle J Olson; Thomas G Pickering; Richard Russell; Mary Woo; Terry Young Journal: Circulation Date: 2008-08-25 Impact factor: 29.690
Authors: Sripal Bangalore; Andrei Breazna; David A DeMicco; Chuan-Chuan Wun; Franz H Messerli Journal: J Am Coll Cardiol Date: 2015-04-21 Impact factor: 24.094
Authors: Kui-Kai Lau; Yuen-Kwun Wong; Kay-Cheong Teo; Richard S K Chang; Koon-Ho Chan; Sonny F K Hon; Ka-Lung Wat; Raymond T F Cheung; Leonard S W Li; Chung-Wah Siu; Hung-Fat Tse Journal: Am J Hypertens Date: 2014-05-18 Impact factor: 2.689
Authors: Joep Perk; Guy De Backer; Helmut Gohlke; Ian Graham; Zeljko Reiner; Monique Verschuren; Christian Albus; Pascale Benlian; Gudrun Boysen; Renata Cifkova; Christi Deaton; Shah Ebrahim; Miles Fisher; Giuseppe Germano; Richard Hobbs; Arno Hoes; Sehnaz Karadeniz; Alessandro Mezzani; Eva Prescott; Lars Ryden; Martin Scherer; Mikko Syvänne; Wilma J M Scholte op Reimer; Christiaan Vrints; David Wood; Jose Luis Zamorano; Faiez Zannad Journal: Eur Heart J Date: 2012-05-03 Impact factor: 29.983