Risk Factor Variability and Cardiovascular Outcome: JACC Review Topic of the Week

Area of Science:

• Cardiovascular Medicine
• Clinical Risk Assessment
• Biostatistics

Background:

• Intraindividual visit-to-visit variability of cardiovascular risk factors was previously overlooked.
• Emerging evidence suggests this variability is a critical, independent risk factor.

Purpose of the Study:

• To highlight the significance of visit-to-visit variability in cardiovascular risk factors.
• To emphasize the need to consider variability alongside average levels in risk assessment.

Main Methods:

• Review of existing literature demonstrating the impact of variability in blood pressure, cholesterol, glycemia, and body weight.
• Analysis of associations between risk factor variability and adverse cardiovascular and all-cause outcomes.

Main Results:

• Visit-to-visit blood pressure variability independently predicts stroke.
• Variability in cholesterol, glycemia, and body weight also increases risk independently of average values.
• Risk factor variability predicts mortality, stroke, coronary artery disease, heart failure, renal disease, and dementia.

Conclusions:

• Cardiovascular risk factors should be assessed by both sustained elevation and visit-to-visit variability.
• Monitoring risk factor variability is crucial for comprehensive cardiovascular risk stratification.
• Heart rate variability is a notable exception requiring distinct interpretation.