Prognostic significance of visit-to-visit variability, and maximum and minimum LDL cholesterol in diabetes mellitus
Abstract Background Current guidelines for dyslipidemia management recommend that the LDL-C goal be lower than 70 mg/dL. The present study investigated the prognostic significance of visit-to-visit variability in LDL-C, and minimum and maximum LDL-C during follow-up in diabetes mellitus. Methods The...
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| Format: | Article |
| Language: | English |
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BMC
2022-02-01
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| Series: | Lipids in Health and Disease |
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| Online Access: | https://doi.org/10.1186/s12944-022-01628-8 |
| _version_ | 1818973781980348416 |
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| author | Chang-Sheng Sheng Ya Miao Lili Ding Yi Cheng Dan Wang Yulin Yang Jingyan Tian |
| author_facet | Chang-Sheng Sheng Ya Miao Lili Ding Yi Cheng Dan Wang Yulin Yang Jingyan Tian |
| author_sort | Chang-Sheng Sheng |
| collection | DOAJ |
| description | Abstract Background Current guidelines for dyslipidemia management recommend that the LDL-C goal be lower than 70 mg/dL. The present study investigated the prognostic significance of visit-to-visit variability in LDL-C, and minimum and maximum LDL-C during follow-up in diabetes mellitus. Methods The risk of outcomes in relation to visit-to-visit LDL-C variability was investigated in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid trial. LDL-C variability indices were coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV). Multivariable Cox proportional hazards models were employed to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI). Results Compared with the placebo group (n=2667), the fenofibrate therapy group (n=2673) had a significantly (P<0.01) lower mean plasma triglyceride (152.5 vs. 178.6 mg/dL), and total cholesterol (158.3 vs.162.9 mg/dL) but a similar mean LDL-C during follow-up (88.2 vs. 88.6 mg/dL, P>0.05). All three variability indices were associated with primary outcome, total mortality and cardiovascular mortality both in the total population and in the fenofibrate therapy group but only with primary outcome in the placebo group. The minimum LDL-C but not the maximum during follow-up was significantly associated with various outcomes in the total population, fenofibrate therapy and placebo group. The minimum LDL-C during follow-up ≥70 mg/dL was associated with an increased risk for various outcomes. Conclusions Visit-to-visit variability in LDL-C was a strong predictor of outcomes, independent of mean LDL-C. Patients with LDL-C controlled to less than 70 mg/dL during follow-up might have a benign prognosis. ClinicalTrials.gov number: NCT 00000620. |
| first_indexed | 2024-12-20T15:29:38Z |
| format | Article |
| id | doaj.art-544c32205ffb4f9aacd0781116453c8f |
| institution | Directory Open Access Journal |
| issn | 1476-511X |
| language | English |
| last_indexed | 2024-12-20T15:29:38Z |
| publishDate | 2022-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Lipids in Health and Disease |
| spelling | doaj.art-544c32205ffb4f9aacd0781116453c8f2022-12-21T19:35:38ZengBMCLipids in Health and Disease1476-511X2022-02-012111910.1186/s12944-022-01628-8Prognostic significance of visit-to-visit variability, and maximum and minimum LDL cholesterol in diabetes mellitusChang-Sheng Sheng0Ya Miao1Lili Ding2Yi Cheng3Dan Wang4Yulin Yang5Jingyan Tian6Department 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 MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, State Key Laboratory of Medical Genomics, Clinical Trial Center, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai Key Laboratory of Complex Prescriptions and MOE Key Laboratory for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese MedicineDepartment 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 MedicineDepartment 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 MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, State Key Laboratory of Medical Genomics, Clinical Trial Center, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, State Key Laboratory of Medical Genomics, Clinical Trial Center, Ruijin Hospital, Shanghai Jiaotong University School of MedicineAbstract Background Current guidelines for dyslipidemia management recommend that the LDL-C goal be lower than 70 mg/dL. The present study investigated the prognostic significance of visit-to-visit variability in LDL-C, and minimum and maximum LDL-C during follow-up in diabetes mellitus. Methods The risk of outcomes in relation to visit-to-visit LDL-C variability was investigated in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid trial. LDL-C variability indices were coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV). Multivariable Cox proportional hazards models were employed to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI). Results Compared with the placebo group (n=2667), the fenofibrate therapy group (n=2673) had a significantly (P<0.01) lower mean plasma triglyceride (152.5 vs. 178.6 mg/dL), and total cholesterol (158.3 vs.162.9 mg/dL) but a similar mean LDL-C during follow-up (88.2 vs. 88.6 mg/dL, P>0.05). All three variability indices were associated with primary outcome, total mortality and cardiovascular mortality both in the total population and in the fenofibrate therapy group but only with primary outcome in the placebo group. The minimum LDL-C but not the maximum during follow-up was significantly associated with various outcomes in the total population, fenofibrate therapy and placebo group. The minimum LDL-C during follow-up ≥70 mg/dL was associated with an increased risk for various outcomes. Conclusions Visit-to-visit variability in LDL-C was a strong predictor of outcomes, independent of mean LDL-C. Patients with LDL-C controlled to less than 70 mg/dL during follow-up might have a benign prognosis. ClinicalTrials.gov number: NCT 00000620.https://doi.org/10.1186/s12944-022-01628-8LDL cholesterolVariabilityDiabetes mellitusACCORD trial |
| spellingShingle | Chang-Sheng Sheng Ya Miao Lili Ding Yi Cheng Dan Wang Yulin Yang Jingyan Tian Prognostic significance of visit-to-visit variability, and maximum and minimum LDL cholesterol in diabetes mellitus Lipids in Health and Disease LDL cholesterol Variability Diabetes mellitus ACCORD trial |
| title | Prognostic significance of visit-to-visit variability, and maximum and minimum LDL cholesterol in diabetes mellitus |
| title_full | Prognostic significance of visit-to-visit variability, and maximum and minimum LDL cholesterol in diabetes mellitus |
| title_fullStr | Prognostic significance of visit-to-visit variability, and maximum and minimum LDL cholesterol in diabetes mellitus |
| title_full_unstemmed | Prognostic significance of visit-to-visit variability, and maximum and minimum LDL cholesterol in diabetes mellitus |
| title_short | Prognostic significance of visit-to-visit variability, and maximum and minimum LDL cholesterol in diabetes mellitus |
| title_sort | prognostic significance of visit to visit variability and maximum and minimum ldl cholesterol in diabetes mellitus |
| topic | LDL cholesterol Variability Diabetes mellitus ACCORD trial |
| url | https://doi.org/10.1186/s12944-022-01628-8 |
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