Impact of Cholesterol Variability as a Potential Residual Cardiovascular Risk Factor in the Elderly: Large Multicenter Common Data Model Database Analysis

Background and Objectives: Variability and cumulative exposure to serum cholesterol have been linked to cardiovascular outcomes.This study aimed to distinguish their impact on major adverse cardiovascular events (MACEs) in elderly patients.Methods: Data from 4,413 elderly patients who are not maintained on cholesterol-lowering therapy for 8 years from 3 Korean tertiary hospitals were analyzed.Based on 8-year cholesterol levels, patients were grouped through coefficient of variation (CV) and cumulative exposure estimates (CEEs).MACE outcomes (death, myocardial infarction [MI], and stroke) over the next 5 years were then compared between these groups.Results: The average patient age was 70.5 years with 56.1% comprising of male participants.A higher CV was associated with increased cardiovascular risks; however, CEE did not demonstrate such trend.A weak negative correlation was found between CV and CEE ( = -0.22,p<0.01).The high-CV/low-CEE group had the highest MACE rate, whereas the low-CV/high-CEE group had the lowest (13.1% vs. 4.7%, p<0.01).The MACE variance was mainly attributed to the differences in death and MIs.A high CV emerged as an independent risk factor, regardless of CEE.Conclusions: Among the elderly, cholesterol variability between visits was more indicative of MACE than cumulative cholesterol exposure over time.