Physicians' Academy for Cardiovascular Education

Higher cholesterol variability associated with increased incidence of CV outcomes

Cholesterol variability and the risk of mortality, myocardial infarction, and stroke: a nationwide population-based study

Literature - Kim MK, Han K, Kim H-S, et al. - Eur Heart J 2017;38:3560–3566

Main results

Conclusion

In a large population-based cohort study, TC variability was an independent predictor for the development of MI and stroke, as well as for all-cause mortality in the general population. These data suggest that reducing TC variability may be of benefit in the primary prevention of CVD.

Editorial comment

In his editorial article, Bangalore [5] notes that intra-individual variability in hemodynamic factors, such as blood pressure, is a sign of life. He raises a number of open questions related to the association between cholesterol variability and clinical outcomes as studied by Kim et al. He first questions whether the association is causal or merely a bystander-effect, and does this in the context of Hill’s 9 criteria for causation [6]. Although many of the criteria are satisfied, Bangalore concludes that the causality of the relationship is far from perfect. He then discusses practical difficulties, like the lack of measures and cut-offs for cholesterol variability. He concludes: ‘Moreover, the clinical implications are not known. At present, increased variability may represent potential medication noncompliance and, if not, perhaps consideration should be given to use a high-intensity statin given data showing reduced cholesterol variability. However, it is not known if reducing cholesterol variability will indeed impact prognosis. Before any of these are incorporated into clinical practice, more studies are needed to test whether this is ‘causal’ or merely an epidemiological association.’

References

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