title: Visit-to-visit variability in LDL- and HDL-cholesterol is associated with adverse events after ST-segment elevation myocardial infarction: A 5-year follow-up study.
abstract: BACKGROUND
  We evaluated the relationship between visit-to-visit low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) variability and 5-year clinical outcomes in patients who presented with ST-segment elevation myocardial infarction (STEMI).
  
  
  METHODS
  130 patients presenting with STEMI and surviving to discharge were analyzed. Visit-to-visit LDL-C and HDL-C variability was evaluated from 2 months after discharge on the basis of corrected variation independent of mean (cVIM, primary measure), coefficient of variation and standard deviation. Major adverse cardiac event (MACE) included death, myocardial infarction, stroke, unplanned revascularization, and heart failure admission.
  
  
  RESULTS
  After an average of 62.4 ± 30.5 months follow-up, 41 patients (31.5%) had experienced MACE. Compared with the non-MACE group, the MACE group had a higher visit-to-visit LDL-C variability (cVIM: 0.23 ± 0.11 vs. 0.19 ± 0.08; p = 0.049; coefficient of variation: 0.24 ± 0.12 vs. 0.19 ± 0.00; p = 0.019; standard deviation: 24.1 ± 14.5 vs. 17.6 ± 10.0; p = 0.006), mean follow-up LDL-C (p = 0.033) and a higher prevalence of diabetes mellitus (p = 0.012). After adjusting for mean follow-up cholesterol levels and diabetes mellitus, each 0.01 cVIM increase in LDL-C and HDL-C variability increased the risk of MACE by 3.4% (HR: 1.034; 95% CI: 1.004 to 1.065; p = 0.025) and 6.8% (HR: 1.068; 95% CI: 1.003 to 1.137; p = 0.04), respectively. Results derived from coefficient of variation and standard deviation as measures of cholesterol variability were similar.
  
  
  CONCLUSIONS
  This is the first report to show an independent association between visit-to-visit LDL-C and HDL-C variability and long-term MACE in patients presenting with STEMI.
authors.affiliation: Department of Cardiology, National University Heart Centre Singapore, Singapore.
authors.forename: Elaine
authors.initials: E
authors.lastname: Boey
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
authors.forename: Gibson Ming Wei
authors.initials: GM
authors.lastname: Gay
authors.affiliation: Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Kian-Keong
authors.initials: KK
authors.lastname: Poh
authors.affiliation: Department of Cardiology, National University Heart Centre Singapore, Singapore.
authors.forename: Tiong-Cheng
authors.initials: TC
authors.lastname: Yeo
authors.affiliation: Department of Cardiology, National University Heart Centre Singapore, Singapore.
authors.forename: Huay-Cheem
authors.initials: HC
authors.lastname: Tan
authors.affiliation: Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: mdclchr@nus.edu.sg.
authors.forename: Chi-Hang
authors.initials: CH
authors.lastname: Lee
mesh_terms: D015415:Biomarkers / Q000097:blood; D002423:Cause of Death / Q000639:trends; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D009819:Office Visits; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL
keywords: Cholesterol; Coronary artery; Long-term; Outcomes; Variability