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Visit-to-visit variability of metabolic parameters and risk of heart failure: A nationwide population-based study
Soonil Kwon1, So-Ryoung Lee1, Eue-Keun Choi1
1Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Insights
High variability in blood pressure, BMI, blood glucose, and cholesterol significantly increases heart failure risk. This metabolic variability, measured by the MV score, shows a dose-dependent relationship with heart failure incidence.
Area of Science:
- Cardiology
- Metabolic Health
- Public Health
Background:
- The impact of metabolic parameter variability on heart failure (HF) risk is not well understood.
- Key metabolic factors include systolic blood pressure (BP), body mass index (BMI), fasting blood glucose (FBG), and total cholesterol (TC).
Purpose of the Study:
- To investigate the association between the variability of four metabolic parameters and the risk of developing heart failure.
- To quantify the cumulative effect of metabolic variability on incident HF.
Main Methods:
- A large cohort study of 3,820,191 adults aged ≥40 years without pre-existing hypertension, diabetes, or dyslipidemia was analyzed.
- Metabolic parameter variability was assessed using the variability independent of the mean (VIM) method.
- A metabolic variability (MV) score was developed based on the quartile ranking of individual parameter VIMs.
Main Results:
- Over a mean follow-up of 5.3 years, 17,253 (0.45%) participants developed incident HF.
- Increased variability in BP, BMI, FBG, and TC was independently associated with a higher risk of HF.
- A dose-dependent relationship was observed, with higher MV scores correlating with significantly increased adjusted hazard ratios for HF (e.g., MV score=4 had an adjusted HR of 1.74 [1.55-1.96]).
Conclusions:
- Elevated variability in systolic BP, BMI, FBG, and TC is synergistically linked to a greater incidence of new-onset heart failure.
- These findings highlight metabolic parameter variability as a crucial, independent risk factor for heart failure development.
Background:
This study examined the effects of variability of four metabolic parameters, namely systolic blood pressure (BP), body mass index (BMI), fasting blood glucose (FBG), and total cholesterol level (TC) on the risk of HF. The effects of metabolic parameter variability on the risk of heart failure (HF) remain unclear.
Methods:
We studied individuals aged ≥40 years who had undergone ≥3 health check-ups under the Korean National Health Insurance Corporation during 2009 and 2012, and those who did not have hypertension, diabetes, or dyslipidemia. BP, BMI, FBG, and TC were measured at every visit. We defined the variability of each parameter using the variability independent of the mean (VIM) method. VIMs were categorized into four groups according to quartiles. The metabolic variability (MV) score for each subject was defined as the number of VIMs in the highest quartile.
Results:
Among the 3,820,191 subjects, 17,253 (0.45%) had incident HF during a mean 5.3 ± 1.1 years of follow-up. High variability of each parameter was associated with increased HF risk, which increased according to the MV score. After multivariable adjustment, compared to subjects with MV score = 0, subjects with MV score = 1-4 had an increased risk of HF (adjusted HR [95% CI], 1.15 [1.10-1.19] for MV score = 1, 1.33 [1.28-1.39] for MV score = 2, 1.48 [1.40-1.57] for MV score = 3, 1.74 [1.55-1.96] for MV score = 4 [p-for-trend ≪0.0001]).
Conclusions:
High variability of BP, BMI, FBG, and TC was synergistically associated with a higher incidence of new-onset HF.
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