Key result
Higher visit-to-visit variability of HDL-C was significantly associated with an increased risk of new-onset heart failure (HR 13.757).
Why the study?
The long-term prognostic value of visit-to-visit cholesterol variability for heart failure risk was uncertain.
Does higher visit-to-visit cholesterol variability predict heart failure and adverse cardiovascular events in adult primary care patients?
Cohort (n=5,662)
Yes
Does higher visit-to-visit cholesterol variability predict heart failure and adverse cardiovascular events in adult primary care patients?
Hazard Ratio: 13.757 (95% CI 6.261–30.226)
p-value: p=<0.0001
Higher visit-to-visit cholesterol variability is associated with significantly increased long-term risks of heart failure and myocardial infarction, though these associations may be negated by the use of lipid-lowering medications.
May support incorporating variability into HF risk assessment in primary care; leaves open whether targeting it improves outcomes.
Background Dyslipidaemia is associated with adverse cardiovascular outcomes. However, the long-term prognostic value of visit-to-visit cholesterol variability for the risks of heart failure (HF) is uncertain. We investigated the associations between cholesterol variability and the risk of HF and adverse cardiovascular events. Methods This retrospective cohort study included patients attending family medicine clinics in Hong Kong during 2000-2003 with follow-up until 2019. Patients with at least three sets of blood cholesterol (low-density (LDL-C) and high-density (HDL-C) lipoprotein cholesterol) levels available at different visits were included. Patients with prior HF, myocardial infarction (MI), use of HF medications, and pregnancy were excluded. Visit-to-visit variability was calculated using standard deviation and coefficient of variation (CV). The primary outcome was HF. The secondary outcomes were cardiovascular mortality, and myocardial infarction. Results A total of 5662 patients were included (2152 males; mean age 63.3±12.4 years; mean follow-up 15.3±4.6 years). Higher variability of HDL-C (hazard ratio (HR) for CV: 13.757 [6.261, 30.226], p<0.0001) predicted new-onset HF. Higher variability of LDL-C (HR for CV: 3.885 [1.942, 7.775], p=0.0001) and HDL-C (HR for CV: 39.118 [13.583, 112.657], p<0.0001) predicted higher risk of MI, but not cardiovascular mortality. These associations remained significant in patients without baseline usage of lipid-lowering medication(s) (N=4068), but were all insignificant in patients with baseline usage of lipid-lowering medication(s) (N=1594). Conclusion Higher visit-to-visit cholesterol variability was varyingly associated with significantly increased long-term risks of HF and adverse cardiovascular events. Such associations may be negated by using lipid-lowering medication(s).
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Chan et al. (2021) conducted a cohort in Dyslipidaemia / Cardiovascular Risk (n=5,662). High visit-to-visit cholesterol variability (HDL-C and LDL-C) vs. Lower visit-to-visit cholesterol variability was evaluated on New-onset heart failure (HR 13.757, 95% CI 6.261-30.226, p=<0.0001). Higher visit-to-visit variability of HDL-C was significantly associated with an increased risk of new-onset heart failure (HR 13.757).
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