2186-P: Lipid Variability Is Associated with Incident Heart Failure and Elevation in NT-proBNP in the Multiethnic Study of Atherosclerosis

Introduction and Objective: The potential role of visit-to-visit variability in lipid parameters in risk of heart failure (HF) is incompletely understood. The relationship between lipid variability and both subclinical markers of HF and events, if established, would suggest an early link with HF. We examined these relationships in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Methods: Visit-to-visit variability of LDL cholesterol (CV-LDL) and the logarithm of triglyceride (CV-logTrig) were estimated by coefficient of variation (CV). HF events were formally adjudicated. HF events through MESA Exam 5 (~10 years) were included. Those with 3 or more lipid measures prior to HF event were included. N-terminal B-type natriuretic peptide (NT-proBNP) was measured at Exam 5 of MESA. We used Cox proportional hazards models to assess the role of variability in lipid parameters in risk of HF events. Logistic regression was used to test an association between lipid variability and risk of elevated (>125 pg/mL) and severely elevated (>450 pg/mL) NT-proBNP levels at Exam 5. Results: After adjustment for HF risk factors, CV-logTrig and CV-LDL were significantly associated with risk of HF (HR = 1.47 [95% CI = 1.29-1.66]; HR = 1.51 [95% CI = 1.35-1.74], respectively - all p < 0.001). CV-logTrig and CV-LDL were also associated with elevated NT-proBNP (>125 pg/mL) at Exam 5 (for CV-logTrig, OR = 1.09 [95% CI = 1.01-1.18], p = 0.03; for CV-LDL, OR = 1.16 [95% CI = 1.03-1.22], p = 0.01). These associations were even stronger when considering Exam 5 elevation in NT-proBNP above 450 pg/mL (for CV-logTrig, OR = 1.28 [95% CI = 1.11-1.47], p < 0.001; for CV-LDL, OR = 1.26 [95% CI = 1.08-1.47], p = 0.004). Conclusion: In MESA, visit-to-visit variability of lipids was associated with risk of HF events, and a dose-dependent association was observed with elevations in NT-proBNP. These data suggest that variability in lipids could play an early pathologic role in the development of HF events. Disclosure D.S. Nuyujukian: None. J. Zhou: None. D.R. Miller: None. A.G. Bertoni: None. P. Reaven: Research Support; Current; Dexcom, Inc., Lilly Global Health Partnership. Funding American Diabetes Association (1-24-PDF-57), NIH/NHLBI (L30HL159815), NIH/NIDDK (R01DK142026)