Visit-to-Visit Low-Density Lipoprotein Cholesterol Variability and Risk of Cardiovascular Outcomes
Key result
Higher visit-to-visit LDL-C variability is linked to ~16% more coronary events per SD in CAD.
- HR 1.16
- 95% CI 1.10 to 1.23
- P<0.0001
- n=9,572
Why the study?
Does visit-to-visit LDL-C variability predict cardiovascular outcomes in patients with coronary artery disease?
Population
9,572 patients with coronary artery disease and LDL-C <130 mg/dl enrolled in the TNT trial, with at least…
Comparison
Higher visit-to-visit LDL-C variability vs Lower visit-to-visit LDL-C variability
Design
Cohort, Randomly assigned to receive atorvastatin 80 mg/day versus 10 mg/day
Authors
Discussion
Loading...
Member takes
Implication
Visit-to-visit LDL-C variability is an independent predictor of cardiovascular events in patients with coronary artery disease, regardless of the achieved LDL-C level.
Key Points
- To determine whether visit-to-visit fluctuations in low-density lipoprotein cholesterol (LDL-C) influence cardiovascular event rates in patients with established coronary artery disease.
- Analyzed data from 9,572 patients with coronary artery disease and LDL-C <130 mg/dL enrolled in the TNT trial who were randomly assigned to atorvastatin 80 mg/day or 10 mg/day.
- Quantified visit-to-visit LDL-C variability beginning 3 months post-randomization using standard deviation (SD) and average successive variability (ASV) as primary metrics.
- Evaluated primary coronary events and secondary endpoints (all-cause mortality, cardiovascular events, myocardial infarction, and stroke) adjusted for achieved LDL-C and adherence.
- Patients receiving atorvastatin 80 mg/day had significantly lower LDL-C variability than those receiving 10 mg/day (SD: 12.03 ± 9.70 vs. 12.52 ± 7.43, p=0.005; ASV: 12.84 ± 10.48 vs. 13.76 ± 8.69, p<0.0001).
- Each 1-SD increment in LDL-C variability (by ASV) was associated with a higher risk of any coronary event (HR: 1.16; 95% CI: 1.10–1.23; p<0.0001) and any cardiovascular event (HR: 1.11; 95% CI: 1.07–1.15; p<0.0001).
- Increased LDL-C variability independently predicted stroke (HR: 1.17; 95% CI: 1.04–1.31; p=0.01), myocardial infarction (HR: 1.10; 95% CI: 1.02–1.19; p=0.02), and death (HR: 1.23; 95% CI: 1.14–1.34; p<0.0001).
Study Design
Type
RCT (n=9,572)
Randomization
randomly assigned
Structured PICO
Does visit-to-visit LDL-C variability predict cardiovascular outcomes in patients with coronary artery disease?
P
Population
9,572 patients with coronary artery disease and LDL-C <130 mg/dl enrolled in the TNT trial.
I
Intervention
Higher visit-to-visit LDL-C variability (evaluated via SD, average successive variability [ASV], coefficient of variation, and variation independent of mean)
C
Comparator
Lower visit-to-visit LDL-C variability
O
Outcome
Any coronary eventcomposite
Main Result
Hazard Ratio: 1.16 (95% CI 1.1–1.23)
p-value: p=< 0.0001
Visit-to-visit LDL-C variability is an independent predictor of cardiovascular events in patients with coronary artery disease, regardless of the achieved LDL-C level.
Cite This Study
Bangalore et al. (2015) conducted an RCT in coronary artery disease and LDL-C <130 mg/dl (n=9,572). Visit-to-visit LDL-C variability was evaluated on any coronary event (HR 1.16, 95% CI 1.10 to 1.23, p=< 0.0001). Each 1-SD increase in visit-to-visit LDL-C variability increased the risk of any coronary event by 16% (HR 1.16; 95% CI 1.10-1.23; P<0.0001) in patients with coronary artery disease.