Physicians' Academy for Cardiovascular Education

Lipid level variability is predictive of cardiovascular events

Visit-to-visit variability of lipid measurements as predictors of cardiovascular events

Presented in part at the American Heart Association Annual Scientific Sessions, November 2017

Literature - Waters DD, Bangalore S, Fayyad R, et al. - J Clin Lipidol 2018;12:356–366

Introduction and methods

Long-term variability of total cholesterol and LDL-c levels have been associated with an increased risk of CV events [1,2]. However, it is not known, whether variations of HDL-c and triglyceride (TG) levels are also linked to increased CV risk.

This post hoc analysis of the Treating to New Targets (TNT) trial [3,4 evaluated whether HDL-c and TG variability predict coronary and CV events, and incident diabetes, in 9572 patients. Moreover, the correlation among LDL-c, HDL-c and TG variability was assessed, and the relative strength of these measures of variability in predicting CV events was investigated.

In the TNT trial, patients aged 35-75 years with clinically evident coronary disease and elevated lipid levels were randomly assigned to atorvastatin 10 mg or 80 mg/day, and followed up for a median of 4.9 years. The main measure of lipid variability for this analysis was the average successive variability (ASV), defined as the average absolute difference between successive values of the available HDL-c, TG, or LDL-c levels.

The primary outcome was the occurrence of any coronary event, defined as coronary heart disease death, nonfatal myocardial infarction (MI), resuscitated cardiac arrest, revascularization, or angina. The secondary outcomes were any CV event (any coronary event or cerebrovascular event, peripheral vascular disease, hospitalization for heart failure), death, MI, stroke, or incident diabetes.

Main results


Visit-to-visit variability in fasting measurements of HDL-c, TG, and LDL-c are predictive of coronary events, CV events, and TG and LDL-c variability, are also predictive of incident diabetes. The mechanisms accounting for these associations remain to be determined.


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Find this article online at J Clin Lipidol

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