Visit-to-Visit Variability in Lipid Levels and Risk of Incident Heart Failure in Adults With Type 2 Diabetes

Limited data exist on the relation between long-term variability in blood lipid fractions and incident heart failure (HF) in the setting of type 2 diabetes mellitus (T2DM).

Among 9,443 participants with T2DM from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, with lipid measurements available at six time points (baseline, 4, 8, 12, 24, and 36 months), we assessed variability in total cholesterol (TC), LDL cholesterol, HDL cholesterol, and triglycerides (TG) across visits, using coefficient of variation (CV), SD, and variability independent of the mean. Cox proportional hazards models were employed to estimate adjusted hazard ratios (HRs) for incident HF.

During a median follow-up of 5.0 years, 345 participants developed HF. Participants in the highest quartile of CV of TC had a 68% higher relative risk of HF compared with those in the lowest quartile (adjusted HR [aHR] 1.68, 95% CI 1.22-2.30). Similarly, those in the highest quartile of LDL cholesterol CV had a 76% higher relative risk (aHR 1.76, 95% CI 1.27-2.42) of HF, while those in the highest quartile of HDL cholesterol CV had a 53% higher risk (aHR 1.53, 95% CI 1.13-2.06). For TG CV, participants in the highest quartile had a 49% higher risk of HF compared with the lowest quartile (aHR 1.49, 95% CI 1.09-2.04). Similar patterns were observed for other variability metrics.

Increased variability in TC, LDL cholesterol, HDL cholesterol, or TG is independently associated with a higher HF risk among individuals with T2DM.