Key result
Visit-to-visit variability in CV risk factors linked to increased risk of adverse cardiovascular outcomes.
Why the study?
Intraindividual visit-to-visit variability of cardiovascular risk factors was historically dismissed as random fluctuation rather than an independent risk factor for adverse outcomes.
Cardiovascular risk factors should be defined by both the magnitude of sustained elevation and their visit-to-visit variability over time.
Visit-to-visit variability may flag higher CV risk beyond mean values; leaves open whether targeting it improves outcomes.
Until recently, intraindividual visit-to-visit variability of cardiovascular risk factors has been dismissed as random fluctuation. This simplistic concept was challenged by demonstrating that visit-to-visit blood pressure variability, independent of average blood pressure, was a powerful risk factor for stroke. Subsequently, variability of other cardiovascular risk factors such as cholesterol, glycemia, and body weight was documented to increase risk independent of their absolute values. Variability of these risk factors has been demonstrated to be a powerful predictor for all-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease, and dementia. With the notable exception of heart rate, cardiovascular risk factors must now be defined by 2 components: the magnitude and duration of sustained risk factor elevation and, equally important, the variability of the same risk factor over time.
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Messerli et al. (2019) conducted a review in Cardiovascular disease. Visit-to-visit variability of cardiovascular risk factors was evaluated on All-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease, and dementia. Visit-to-visit variability of cardiovascular risk factors, such as blood pressure, cholesterol, glycemia, and body weight, independently increases the risk of adverse cardiovascular outcomes.
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