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Cardiovascular Outcomes and Variability in Plasma Lipid Levels Across Body Mass Index Categories: The ARIC Study
Tianyu Xu1,2, Chang Chen1,2, De-Wei An3,4
1Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Insights
High variability in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) is linked to increased cardiovascular risk, especially in individuals with obesity. Lipid variability measurements significantly improve heart failure risk prediction in obese patients.
Area of Science:
- Cardiovascular Medicine
- Metabolic Disorders
- Biostatistics
Background:
- Obesity is a major risk factor for cardiovascular disease and dyslipidemia.
- Lipid levels and their variability may play a crucial role in cardiovascular risk stratification.
Purpose of the Study:
- To investigate the association between lipid variability (total cholesterol [TC] and low-density lipoprotein cholesterol [LDL-C]) and cardiovascular outcomes (heart failure [HF], myocardial infarction [MI], mortality).
- To examine these associations across different body mass index (BMI) categories, including obesity.
- To determine if lipid variability improves cardiovascular risk prediction beyond conventional risk factors.
Main Methods:
- Analysis of 6689 participants from the Atherosclerosis Risk In Communities (ARIC) study with at least three TC and LDL-C measurements.
- Cox regression models were used to calculate hazard ratios (HRs) for cardiovascular outcomes associated with lipid variability (SD and VIM).
- Evaluation of the incremental predictive value of lipid variability metrics when added to a conventional cardiovascular risk model.
Main Results:
- Elevated TC and LDL-C variability were significantly associated with increased risk of HF across overweight and obesity classes (I, II, and III).
- Higher TC and LDL-C variability were linked to increased risk of MI and mortality in obesity classes I and II.
- Incorporating TC-VIM and LDL-C-VIM into risk models significantly improved HF risk prediction, showing substantial net reclassification improvement (8.95% for TC-VIM, 8.09% for LDL-C-VIM).
Conclusions:
- Elevated TC and LDL-C variability are associated with a higher risk of cardiovascular outcomes, particularly in individuals with obesity.
- Lipid variability is an important factor to consider in managing dyslipidemia associated with obesity.
- Lipid variability metrics offer significant potential for enhancing cardiovascular risk prediction models, especially for heart failure.
Abstract:
The aim of this study was to investigate associations of cardiovascular outcomes with lipid variability across body mass index categories. We identified 6689 participants (57.1% women) enrolled in the Atherosclerosis Risk In Communities (ARICs) study who had ≥ 3 measurements of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). Cox regression models were used to compute hazard ratios (HRs)-associated heart failure (HF), myocardial infarction (MI), and mortality with 1-SD increase in lipid variability captured by SD and variability independent of the mean (VIM). We also assessed whether adding lipid variability would improve the cardiovascular risk prediction beyond the conventional risk factors. Among 2130 (31.8%) obese patients, 1907 (89.5%) had obesity classes I and II and 223 (10.5%) had obesity class III. In multivariable-adjusted analyses, TC and LDL-C variabilities were significantly (p ≤ 0.047) associated with HF in overweight (HRs ranging from 1.10 to 1.17), obesity classes I and II (1.11-1.14), and obesity class III (1.21-1.39). Higher TC and LDL-C variabilities conferred higher risk of MI and mortality in obesity classes I and II (p ≤ 0.007). Adding TC-VIM and LDL-C-VIM rather than the lipid level to a conventional risk model significantly improved risk prediction of HF with net reclassification improvement amounting to 8.95% for TC-VIM (p=0.006) and 8.09% for LDL-C-VIM (p=0.012). Elevated TC and LDL-C variabilities were associated with the increased risk of cardiovascular outcomes, particularly in obesity. Our observations highlight the importance of lipid variability in obesity-associated dyslipidemia.
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