Visit-to-visit cholesterol variability linked to adverse cardiovascular events after percutaneous coronary intervention

  • Lee EY & al.
  • Atherosclerosis
  • 1 Dec 2018

  • from Sarfaroj Khan
  • Clinical Summaries
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Takeaway

  • Visit-to-visit variability in low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and non-HDL-C is significantly associated with increased risk for major adverse cardiovascular and cerebrovascular events (MACCE, composite of all-cause mortality, non-fatal myocardial infarction [MI] and non-fatal stroke) in patients with previous percutaneous coronary intervention (PCI).
  • Findings suggest an important dynamic association between LDL-C, HDL-C and non-HDL-C levels and clinical outcomes.

Why this matters

  • Decreased variability in heart rate has been associated with adverse outcomes such as vascular events, impaired cognition and mortality. However, not much is known about the association between variability in LDL-C, HDL-C and non-HDL-C and cardiovascular outcomes.

Study design

  • Visit-to-visit variability in LDL-C, HDL-C, and non-HDL-C using various indices: standard deviation (SD), coefficient of variation (CV) and corrected variability independent of mean (cVIM) was calculated in 1792 patients (70.9% males) who underwent PCI.
  • Median follow-up period: 65 months (2004 -2009).
  • Primary endpoint: composite of MACCE after index PCI.
  • Funding: None disclosed.

Key results

  • 114 patients (6.4%) experienced MACCE: 68 (3.8%) all-cause death; 43 (2.4%) stroke and 15 (0.8%) non-fatal MI during a median follow-up period of 5.4 years.
  • The cVIM of LDL-C, HDL-C and non-HDL-C was significantly higher in patients with MACCE vs those without MACCE (0.18±0.14 vs 0.13±0.09 [P<.001 vs respectively>
  • After adjustment for potential confounders, each 1-SD increase of cVIM in LDL-C, HDLC and non-HDL-C was associated with an increased the risk for MACCE by 34% (adjusted HR [aHR], 1.34; 95% CI, 1.18-1.52; P<.001 ci p and respectively.>
  • Similar relationships were observed between CV and SD of LDL-C, HDL-C and non-HDL-C and the risk for MACCE.
  • In Kaplan-Meier survival analysis, the highest quartile in cVIM of LDL-C, HDL-C showed a higher risk for MACCE, all-cause mortality, non-fatal stroke and non-fatal MI compared with lower quartiles
  • These relationships were observed in various subgroups according to age, sex and diabetes status.

Limitations

  • Lack of data for medicine adherence.
  • Results may not be generalised, as patients receiving PCI who were at high-risk for cardiovascular disease were analysed.