High Cholesterol Variability May Influence CV Events in General Population, Too

High variability in lipid levels is associated with adverse outcomes including myocardial infarction (MI), stroke, and death, according to a recent study.

It is known that a high visit-to-visit variability in cholesterol levels may be associated with major adverse cardiovascular events in patients with coronary artery disease. However, it is not clear how this type of variability affects cardiovascular risk in the general population.
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To explore this further, the researchers identified and evaluated 3,656,658 patients without history of MI and stroke from the Korean National Health Insurance System cohort. All patients included in the study had received at least 3 health examinations between 2002 and 2007. Median follow-up lasted 8.3 years.

The coefficient of variation (CV), standard deviation (SD), and variability independent of the mean (VIM) were used to measure total cholesterol variability.

Overall, there had been 84,625 (2.3%) deaths, 40,991 (1.1%) cases of MI, and 42,861 (1.2%) cases of stroke. Ultimately, the researchers found a linear association between higher total cholesterol variability and outcome measures, with hazard ratios of 1.26 for all-cause mortality, 1.08 for MI, and 1.11 for stroke. The researchers noted that the risk for stroke was independent of mean total cholesterol levels and the use of lipid-lowering agents.

These findings remained consistent when modeling variability of TC using SD and VIM, and in several sensitivity analyses, the researchers reported.

“High variability in lipid levels is associated with adverse health-related outcomes,” the researchers concluded. “These findings suggest that lipid variability is an important risk factor in the general population.”

—Christina Vogt

Reference:

Kim MK, Han K, Kim HS, et al. Cholesterol variability and the risk of mortality, myocardial infarction, and stroke: a nationwide population-based study. Eur Heart J. 2017;38(48):3560-3566. https://doi.org/10.1093/eurheartj/ehx585.