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Variability in Lipid Levels and Risk for Cardiovascular Disease: An Electronic Health Record-Based Population Cohort
Sheila M Manemann1, Suzette J Bielinski1, Ethan D Moser1
1Department of Quantitative Health Sciences Mayo Clinic Rochester MN.
Insights
High lipid variability, including total cholesterol and LDL cholesterol, is linked to increased cardiovascular disease risk. This variability can be measured using electronic health records, suggesting a potential new risk marker.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Informatics
Background:
- Within-patient variability in lipid levels is a known risk factor for cardiovascular disease (CVD).
- Current clinical practice does not widely utilize lipid variability measures due to data requirements.
- Electronic health records (EHRs) offer a potential platform for calculating lipid variability.
Purpose of the Study:
- To assess the feasibility of calculating lipid variability from EHR data.
- To determine the association between lipid variability and incident CVD in a large population cohort.
Main Methods:
- Utilized EHR data from Olmsted County, MN, identifying individuals aged ≥40 without prior CVD.
- Included patients with ≥3 lipid measurements (total cholesterol, LDL-C, HDL-C, triglycerides) within 5 years pre-index date.
- Calculated lipid variability using the variability independent of the mean (VIM) method and followed patients for incident CVD.
Main Results:
- 19,652 individuals were analyzed, with VIM calculated for at least one lipid type.
- Highest total cholesterol variability was associated with a 20% increased CVD risk (HR 1.20).
- Similar associations were observed for low-density lipoprotein cholesterol and high-density lipoprotein cholesterol variability.
Conclusions:
- High variability in total cholesterol, LDL-C, and HDL-C is associated with increased CVD risk, independent of traditional risk factors.
- Lipid variability shows potential as a novel risk marker and therapeutic target.
- EHR data facilitates lipid variability calculation, but further research is needed for clinical implementation.
Abstract:
Background Larger within-patient variability of lipid levels has been associated with increased risk of cardiovascular disease (CVD); however, measures of lipid variability require ≥3 measurements and are not currently used clinically. We investigated the feasibility of calculating lipid variability within a large electronic health record-based population cohort and assessed associations with incident CVD. Methods and Results We identified all individuals ≥40 years of age who resided in Olmsted County, MN, on January 1, 2006 (index date), without prior CVD, defined as myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention, or CVD death. Patients with ≥3 measurements of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or triglycerides during the 5 years before the index date were retained. Lipid variability was calculated using variability independent of the mean. Patients were followed through December 31, 2020 for incident CVD. We identified 19 652 individuals (mean age 61 years; 55% female), who were CVD-free and had variability independent of the mean calculated for at least 1 lipid type. After adjustment, those with highest total cholesterol variability had a 20% increased risk of CVD (Q5 versus Q1 hazard ratio, 1.20 [95% CI, 1.06-1.37]). Results were similar for low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Conclusions In a large electronic health record-based population cohort, high variability in total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol was associated with an increased risk of CVD, independent of traditional risk factors, suggesting it may be a possible risk marker and target for intervention. Lipid variability can be calculated in the electronic health record environment, but more research is needed to determine its clinical utility.
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