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Prognostic significance of visit-to-visit variability, and maximum and minimum LDL cholesterol in diabetes mellitus

Chang-Sheng Sheng1, Ya Miao2, Lili Ding3

  • 1Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China. scsheng2004@163.com.

Lipids in Health and Disease
|February 11, 2022
PubMed

Insights

High LDL-C variability predicts adverse outcomes in diabetes, independent of average LDL-C levels. Maintaining LDL-C below 70 mg/dL may indicate a better prognosis.

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolic Syndrome

Background:

  • Current dyslipidemia guidelines advocate for LDL-C goals below 70 mg/dL.
  • The prognostic significance of LDL-C variability in diabetes remains under investigation.

Purpose of the Study:

  • To investigate the prognostic significance of visit-to-visit LDL-C variability and extreme LDL-C values (minimum and maximum) during follow-up in patients with diabetes mellitus.

Main Methods:

  • The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid trial data was analyzed.
  • LDL-C variability was assessed using coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV).
  • Multivariable Cox proportional hazards models were used to determine adjusted hazard ratios (HR) and 95% confidence intervals (CI).

Main Results:

  • Fenofibrate therapy significantly reduced triglycerides and total cholesterol but not mean LDL-C compared to placebo.
  • All LDL-C variability indices were associated with primary outcomes, total mortality, and cardiovascular mortality.
  • Lower minimum LDL-C levels (≥70 mg/dL) during follow-up were linked to an increased risk of adverse outcomes.

Conclusions:

  • Visit-to-visit LDL-C variability is a significant predictor of outcomes, irrespective of the mean LDL-C.
  • Patients achieving LDL-C levels below 70 mg/dL during follow-up may experience a more favorable prognosis.
  • The study identified NCT00000620 as the ClinicalTrials.gov identifier.
Abstract

Keywords:
ACCORD trialDiabetes mellitusLDL cholesterolVariability

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