Highlights
- •Visit-to-visit variability in high-density lipoprotein cholesterol, triglycerides, and low-density lipoprotein-cholesterol are predictive of coronary events.
- •Visit-to-visit variability in triglycerides and low-density lipoprotein cholesterol are predictive of incident diabetes.
- •The correlation among the variability of the 3 lipid measurements is weak.
- •The mechanisms accounting for these associations are unknown.
Background
Higher visit-to-visit variability in risk factors such as blood pressure and low-density
lipoprotein (LDL)-cholesterol are associated with an increase in cardiovascular (CV)
events.
Objective
The purpose of this study was to determine whether variability in high-density lipoprotein
cholesterol (HDL-C) and triglyceride levels predicted coronary and CV events in a
clinical trial population with known coronary disease.
Methods
We assessed intraindividual variability in fasting high-density lipoprotein (HDL)-cholesterol,
triglyceride, and LDL-cholesterol measurements among 9572 patients in the Treating
to New Targets trial and correlated the results with coronary events over a median
follow-up of 4.9 years.
Results
In the fully adjusted Cox model, 1 standard deviation of average successive variability,
defined as the average absolute difference between successive values, was associated
with an increased risk of a coronary event for HDL-cholesterol (hazard ratio [HR]
1.16, 95% confidence interval [CI] 1.11–1.21, P < .0001), for triglycerides (HR 1.09, 95% CI 1.04–1.15, P = .0005), and for LDL-cholesterol (HR 1.14, 95% CI 1.09–1.19, P < .0001). Similar results were found for the 3 other measures of variability, standard
deviation, coefficient of variability, and variability independent of the mean. Similar
results were seen for CV events, stroke, and nonfatal myocardial infarction. Higher
variability in triglyceride and LDL-cholesterol, but not HDL-cholesterol, was predictive
of incident diabetes. The correlation among the variability of the 3 lipid measurements
was weak.
Conclusion
Visit-to-visit variability in fasting measurements of HDL-cholesterol, triglycerides,
and LDL-cholesterol are predictive of coronary events, CV events, and for triglyceride
and low-density lipoprotein cholesterol variability, incident diabetes. The mechanisms
accounting for these associations remain to be determined.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: December 20, 2017
Accepted:
December 13,
2017
Received:
October 2,
2017
Footnotes
Funding Source: The TNT trial was sponsored by Pfizer.
Identification
Copyright
© 2017 National Lipid Association. All rights reserved.
