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Kim MK, Han K, Koh ES, Kim HS, Kwon HS, Park YM, Yoon KH, Lee SH. Variability in Total Cholesterol Is Associated With the Risk of End-Stage Renal Disease: A Nationwide Population-Based Study. Arterioscler Thromb Vasc Biol 2017; 37:1963-1970. [PMID: 28860222 DOI: 10.1161/atvbaha.117.309803] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/15/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Recent data suggest that visit-to-visit variability of cholesterol is associated with cardiovascular events. We evaluated the role of lipid variability as a determinant of end-stage renal disease (ESRD). APPROACH AND RESULTS Using nationally representative data from the Korean National Health Insurance System, 8 493 277 subjects who were free of ESRD and who underwent ≥3 health examinations during 2005 to 2010 were followed to the end of 2015. Total cholesterol (TC) variability was measured using the coefficient of variation, SD, and the variability independent of the mean. The primary outcome was the development of ESRD, defined as a combination of the relevant disease code and the initiation of renal replacement therapy. There were 11 247 cases of ESRD during a median follow-up of 6.1 years. There was a graded association between a higher TC variability and incident ESRD. In the multivariable adjusted model, the hazard ratios and 95% confidence intervals comparing the highest versus lowest quartiles of coefficient of variation of TC were 2.66 (95% confidence interval, 2.52-2.82). The results were consistent when the variability of TC was modeled using SD and variability independent of the mean and were independent of preexisting chronic kidney disease. CONCLUSIONS Increasing TC variability was associated with an increasing incidence of ESRD.
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Affiliation(s)
- Mee Kyoung Kim
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Kyungdo Han
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Eun Sil Koh
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Hun-Sung Kim
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Hyuk-Sang Kwon
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Yong-Moon Park
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Kun-Ho Yoon
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Seung-Hwan Lee
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.).
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Bangalore S, Fayyad R, Messerli FH, Laskey R, DeMicco DA, Kastelein JJP, Waters DD. Relation of Variability of Low-Density Lipoprotein Cholesterol and Blood Pressure to Events in Patients With Previous Myocardial Infarction from the IDEAL Trial. Am J Cardiol 2017; 119:379-387. [PMID: 27939230 DOI: 10.1016/j.amjcard.2016.10.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
Abstract
In patients with previous myocardial infarction (MI), aggressive hypertension control and low-density lipoprotein cholesterol (LDL-C) reduction are important secondary prevention measures. However, residual risk remains despite aggressive treatment. Whether variability in blood pressure (BP) and LDL-C can explain this residual risk is not known. Patients enrolled in the Incremental Decrease in End Points Through Aggressive Lipid-Lowering trial with at least 1 post-baseline measurement of LDL-C and blood pressure (BP) were included. Visit-to-visit LDL-C and BP variabilities were evaluated using various measures of variability. Primary outcome was any coronary event with the secondary outcomes of any cardiovascular event (CV), MI, stroke, death, and CV death. Among the 8,658 patients included, each 1-SD (10.8 mg/dl) increase in LDL-C variability increased the risk of any coronary event (adjusted HR [HRadj] 1.07; 95% CI 1.04 to 1.11; p <0.0001), any CV event, MI, and death (HRadj 1.19; 95% CI 1.14 to 1.25; p <0.0001). Similarly, each 1-SD (7.2 mm Hg) increase in systolic BP variability increased the risk of any coronary event (HRadj 1.15; 95% CI 1.10 to 1.20; p <0.0001), any CV event, MI, stroke, death (HRadj 1.28; 95% CI 1.18 to 1.38; p <0.0001), and CV death. Compared with the group with low variability for both LDL-C and systolic BP, the group with high variability for both had a significant increase in any coronary event (HRadj 1.48; 95% CI 1.30 to 1.70), any CV event (HRadj 1.43; 95% CI 1.27 to 1.61), and MI (HRadj 1.87; 95% CI 1.46 to 2.41). In conclusions, in patients with a history of MI, variabilities in LDL-C and BP are powerful and independent predictors of CV events including death.
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Affiliation(s)
- Sripal Bangalore
- Division of Cardiology, New York University School of Medicine, New York, New York.
| | | | - Franz H Messerli
- Division of Cardiology, University Hospital, Bern, Switzerland; Division of Cardiology, Mount Sinai, Icahn School of Medicine, New York, New York
| | | | | | | | - David D Waters
- Division of Cardiology, San Francisco General Hospital, San Francisco, California
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