Variable visit-to-visit cholesterol measures tied to new-onset HF, MI, CV death
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Visit-to-visit HDL and total cholesterol variability were associated with increased risk for new-onset HF in a cohort of patients in Hong Kong, researchers reported.
According to a research letter published in the European Journal of Preventive Cardiology, visit-to-visit LDL and total cholesterol variability were both tied to elevated risk for MI. LDL variability alone was associated with risk for CV death.
“Visit-to-visit cholesterol variability, reflecting fluctuations in cholesterol levels between visits, is prognostic for some adverse cardiovascular outcomes such as cardiac arrhythmias and mortality,” Jeffrey Shi Kai Chan, MBChB, clinical researcher in the family medicine research unit in Cardiovascular Analytics Group in Hong Kong, part of the China-UK Collaboration, and colleagues wrote. “Nonetheless, associations between cholesterol variability and heart failure (HF) remain unclear. This study therefore investigated the associations between LDL-C and HDL-C variabilities and the risk of new-onset HF and major adverse cardiovascular outcomes.”
For this retrospective study, researchers included 5,662 patients (mean age, 63 years; 38% men) who attended any family medicine clinic in Hong Kong from January 2000 through December 2003. Over a mean follow-up of 15.3 years, each patient had a median of 13 sets of lipid profiles.
Participants were excluded if they had known HF, had prior MI, were using HF medications, were pregnant, had known HIV infection or had less than three sets of lipid profiles. The primary outcome was new-onset HF, and the secondary outcomes were CV mortality and MI.
Researchers reported that HDL variability and mean HDL, not LDL, was associated with risk for new-onset HF.
High HDL variability was associated with increased risk for new-onset HF (adjusted HR = 48.68; 95% CI, 21.37-110.9; P < .001), as was low mean HDL (aHR = 0.6; 95% CI, 0.5-0.72; P < .001).
High cholesterol variability was not associated with CV mortality; however, high mean LDL (aHR = 1.37; 95% CI, 1.2-1.55; P < .001) and low mean HDL were (aHR = 0.54; 95% CI, 0.41-0.71; P < .001).
High LDL variability (aHR = 3.64; 95% CI, 1.81-7.33; P < .001) and HDL variability (aHR = 39.87; 95% CI, 13.77-115.47; P < .001) was associated with increased risk for MI, according to the study.
Low mean HDL was associated with increased risk for MI (aHR = 0.46; 95% CI, 0.36-0.6; P < .001) but mean LDL was not.
These results were consistent among a subgroup of patients not taking any lipid-lowering medications.
However, in patients who were taking lipid-lowering medication, LDL and HDL variability were not prognostic of the primary or secondary outcomes.
Researchers reported that total cholesterol variability remained associated with risk for MI (aHR = 25.89; 95% CI, 3.74-179.01; P < .001) in those taking lipid-lowering medications.
“As far as we know, this is the first study demonstrating links between cholesterol variability and new-onset HF risk. Using population-based data with long follow-up, our results are widely applicable,” the researchers wrote. “Clinicians should be aware of the importance of controlling cholesterol fluctuations, and further investigations should explore measures which reduce such fluctuations.”
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