Mee Kyoung Kim1, Kyungdo Han2, Hun-Sung Kim3,4, Yong-Moon Park5, Hyuk-Sang Kwon1, Kun-Ho Yoon3,4, Seung-Hwan Lee3. 1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #10, 63-ro, Yeongdeungpo-gu, 07345 Seoul, Korea. 2. Department of Medical Statistics, College of Medicine, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu, 06591 Seoul, Korea. 3. Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu, 06591 Seoul, Korea. 4. Department of Medical Informatics, College of Medicine, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu, 06591 Seoul, Korea. 5. Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, 111 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA.
Abstract
Aims: A high visit-to-visit variability in cholesterol levels has been suggested to be an independent predictor of major adverse cardiovascular events in patients with coronary artery disease (CAD). Because whether this notion applies to general population is not known, we aimed to investigate the associations between total cholesterol (TC) variability and the risk of all-cause mortality, myocardial infarction (MI), and stroke. Methods and results: We identified 3 656 648 subjects without a history of MI and stroke who underwent ≥3 health examinations from 2002 to 2007 in the Korean National Health Insurance System cohort. Total cholesterol variability was measured using the coefficient of variation (CV), standard deviation (SD), and variability independent of the mean (VIM). There were 84 625 deaths (2.3%), 40 991 cases of MI (1.1%), and 42 861 cases of stroke (1.2%) during the median follow-up of 8.3 years. There was a linear association between higher TC variability and outcome measures. In the multivariable adjusted model, the hazard ratios and 95% confidence intervals comparing the highest vs. lowest quartiles of CV of TC were 1.26 (1.24-1.28) for all-cause mortality, 1.08 (1.05-1.11) for MI, and 1.11 (1.08-1.14) for stroke, which was independent of mean TC levels and the use of lipid-lowering agents. The results were consistent when modelling variability of TC using SD and VIM, and in various sensitivity analyses. Conclusion: High variability in lipid levels is associated with adverse health-related outcomes. These findings suggest that lipid variability is an important risk factor in the general population. Published on behalf of the European Society of Cardiology. All rights reserved.
Aims: A high visit-to-visit variability in cholesterol levels has been suggested to be an independent predictor of major adverse cardiovascular events in patients with coronary artery disease (CAD). Because whether this notion applies to general population is not known, we aimed to investigate the associations between total cholesterol (TC) variability and the risk of all-cause mortality, myocardial infarction (MI), and stroke. Methods and results: We identified 3 656 648 subjects without a history of MI and stroke who underwent ≥3 health examinations from 2002 to 2007 in the Korean National Health Insurance System cohort. Total cholesterol variability was measured using the coefficient of variation (CV), standard deviation (SD), and variability independent of the mean (VIM). There were 84 625 deaths (2.3%), 40 991 cases of MI (1.1%), and 42 861 cases of stroke (1.2%) during the median follow-up of 8.3 years. There was a linear association between higher TC variability and outcome measures. In the multivariable adjusted model, the hazard ratios and 95% confidence intervals comparing the highest vs. lowest quartiles of CV of TC were 1.26 (1.24-1.28) for all-cause mortality, 1.08 (1.05-1.11) for MI, and 1.11 (1.08-1.14) for stroke, which was independent of mean TC levels and the use of lipid-lowering agents. The results were consistent when modelling variability of TC using SD and VIM, and in various sensitivity analyses. Conclusion: High variability in lipid levels is associated with adverse health-related outcomes. These findings suggest that lipid variability is an important risk factor in the general population. Published on behalf of the European Society of Cardiology. All rights reserved.
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: Massimo F Piepoli; Arno W Hoes; Stefan Agewall; Christian Albus; Carlos Brotons; Alberico L Catapano; Marie-Therese Cooney; Ugo Corrà; Bernard Cosyns; Christi Deaton; Ian Graham; Michael Stephen Hall; F D Richard Hobbs; Maja-Lisa Løchen; Herbert Löllgen; Pedro Marques-Vidal; Joep Perk; Eva Prescott; Josep Redon; Dimitrios J Richter; Naveed Sattar; Yvo Smulders; Monica Tiberi; H Bart van der Worp; Ineke van Dis; W M Monique Verschuren; Simone Binno Journal: Eur Heart J Date: 2016-05-23 Impact factor: 29.983
Authors: Sarah L Stevens; Sally Wood; Constantinos Koshiaris; Kathryn Law; Paul Glasziou; Richard J Stevens; Richard J McManus Journal: BMJ Date: 2016-08-09
Authors: Kausik K Ray; Robert M Stoekenbroek; David Kallend; Toshiyuki Nishikido; Lawrence A Leiter; Ulf Landmesser; R Scott Wright; Peter L J Wijngaard; John J P Kastelein Journal: JAMA Cardiol Date: 2019-11-01 Impact factor: 14.676
Authors: Rizwan Kalani; Traci M Bartz; Astrid Suchy-Dicey; Mitchell S V Elkind; Bruce M Psaty; Lester Y Leung; Kenneth Rice; David Tirschwell; W T Longstreth Journal: Stroke Date: 2019-12-17 Impact factor: 7.914
Authors: Matthew W Segar; Kershaw V Patel; Muthiah Vaduganathan; Melissa C Caughey; Javed Butler; Gregg C Fonarow; Justin L Grodin; Darren K McGuire; Ambarish Pandey Journal: Diabetes Care Date: 2020-06-15 Impact factor: 19.112