Title : The association between visit-to-visit variability in established risk factors and incident CVD: A post-hoc analysis of the multi-ethnic study of atherosclerosis
Abstract:
Background: There has been a growing interest in investigating the association between visit-to-visit variability in established risk factors and the incidence of cardiovascular disease (CVD). Some research has demonstrated that larger within-patient variability in certain established risk factors is associated with higher CVD risk. Despite this, measures of variability in CVD risk stratification are not yet clinically implemented as data on the association between variability across multiple risk factors and CVD risk in the general population are still scarce.
Purpose: The aim of this study is to investigate the association between visit-to-visit variability of nine risk factors and incident cardiovascular disease (CVD) in a large multi-ethnic population cohort study.
Methods: We used data from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort study. We included individuals with no previous history of CVD, with at least three repeated measurements. On each risk factor including total cholesterol, HDL, LDL, non-HDL, triglyceride, Chol/HDL ratio, Diastolic Blood Pressure (DBP), Systolic Blood Pressure (DBP), and Body mass index (BMI). Visit-to-visit variability was estimated via the variability independent of the mean (VIM). A Cox proportional hazards model was used to estimate the association between visit-to-visit variability in each risk factor and the hazard of developing CVD, defined as a composite encompassing myocardial infraction (MI), resuscitated cardiac arrest, other atherosclerotic CVD death, and fatal and nonfatal stroke.
Results: The overall 10-year risk of developing CVD in this cohort is 8.9% (95% CI: 8.0%-9.7%). There was a statistically significant association between visit-to-visit variability in systolic blood pressure, body mass index, HDL and the rate of incident CVD. This rate was higher in individuals with high visit-to-visit variability for systolic blood pressure [HR: 1.28, 95% CI: 1.01-1.63, p = 0.04]; for body mass index [HR: 1.58, 95% CI: 1.25-2.00, p < 0.001]; and for HDL [HR: 1.3, 95% CI: 1.03-1.65, p = 0.025], compared to those with low visit to-visit variability. There was no evidence of an association for visit-to-visit variability in the other six risk factors.
Conclusion: Our findings suggest that visit-to-visit variability in some CVD risk factors could be independently associated with incident CVD and may, in addition to traditional risk factors, be clinically used in risk stratification.
