title: Visit-to-Visit Low-Density Lipoprotein Cholesterol Variability Is an Independent Determinant of Carotid Intima-Media Thickness in Patients With Type 2 Diabetes.
abstract: BACKGROUND
  Studies demonstrated that visit-to-visit variability in low-density lipoprotein cholesterol (LDLC) is an independent predictor of cardiovascular events in subjects with coronary artery disease. Whether visit-to-visit variability in LDLC levels affects subclinical atherosclerosis is unknown. This study sought to evaluate the role of visit-to-visit variability in LDLC levels on subclinical atherosclerosis.
  
  
  METHODS
  We evaluated 162 type 2 diabetic patients with measurement of carotid intima-media thickness (IMT). Intrapersonal mean and standard deviation (SD) of six measurements of LDLC during 12 months were calculated. Multivariate linear regressions assessed the independent correlates of carotid IMT.
  
  
  RESULTS
  The mean and SD of LDLC were 112 ± 22 and 15 ± 10 mg/dL, respectively, and 43.2% of patients were on hypolipidemic drugs. Age (standardized β = 0.355, P < 0.001), male sex (standardized β = 0.234, P = 0.002) and SD-LDLC (standardized β = 0.201, P = 0.009) emerged as independent determinants of carotid maximum IMT independently of mean LDLC levels, body mass index (BMI), waist circumference, duration and treatment of diabetes, means and SDs of glycemic and other lipid variables, and uses of hypolipidemic and anti-hypertensive medications (R2= 0.15). Results did not change when mean IMT was used instead of maximum IMT. After controlling for age and sex, maximum IMT was thicker in patients with the highest compared to those with other three quartiles of SD-LDLC combined (1.14 ± 0.04 (SE) vs. 1.01 ± 0.02 mm, P = 0.01). Independent determinants of SD-LDLC were mean LDLC, use of hypolipidemic drugs, fasting triglyceride and visit-to-visit variability in HbA1c.
  
  
  CONCLUSIONS
  Consistency of LDLC levels may be important to subclinical atherosclerosis in real-world patients with type 2 diabetes. It may be important for patients on lipid-lowering drugs to prevent non-compliance.
authors.affiliation: Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Nishinomiya, Hyogo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Takenouchi
authors.affiliation: Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan; Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan.
authors.forename: Ayaka
authors.initials: A
authors.lastname: Tsuboi
authors.affiliation: Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan; Department of Nutritional Sciences for Well-Being, Faculty of Health Sciences for Welfare, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Kitaoka
authors.affiliation: Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan; Graduate School of Human Science and Environment, University of Hyogo, Himeji, Hyogo, Japan.
authors.forename: Satomi
authors.initials: S
authors.lastname: Minato
authors.affiliation: Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Nishinomiya, Hyogo, Japan; Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Kurata
authors.affiliation: Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Nishinomiya, Hyogo, Japan; Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Fukuo
authors.affiliation: Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Nishinomiya, Hyogo, Japan; Division of Diabetes, Department of Medicine, Konan Kakogawa Hospital, Kakogawa, Hyogo, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kazumi
keywords: Annual variability; Carotid intima-media thickness; LDLC; Type 2 diabetes