▲Professor Hyeongjun Joo of Korea University Anam Hospital presented the results of the study on “Cholesterol Variability as a Potential Residual Cardiovascular Risk Factor in the Elderly” at the “Asia-Pacific International Cardiometabolic Syndromes Symposium (APCMS 2024) )” held in Conrad Seoul on the 26th and 27th.
[메디칼업저버 박선혜 기자] The importance of monitoring total cholesterol variability has been highlighted as a management strategy to prevent cardiovascular disease in older adults.
As a result of a nationwide retrospective study, if total cholesterol volatility was elevated, the risk of major cardiovascular events (MACE) was elevated regardless of the estimated cumulative exposure (CEE) of cholesterol. This suggests that variability in total cholesterol is an assessment factor that predicts cardiovascular disease risk.
Professor Hyeongjun Joo (Department of Cardiology) of Anam Hospital of Korea University presented the results of this study at the “Asia-Pacific International Symposium on Cardiometabolic Syndromes (APCMS 2024)” held at Conrad Seoul on the 26th and 27th.
Cholesterol volatility is of interest as an additional risk factor for cardiovascular disease.
CEE is a concept that evaluates the cholesterol load exposed over time. Since cholesterol accumulates in the body, the total amount accumulated in the body over time is statistically deduced based on the confirmed cholesterol level for each test.
Previously published studies have demonstrated that visit-to-visit variability in cholesterol levels is associated with coronary atheroma progression and clinical outcome. Additionally, a national population-based study observed an association between variability in total cholesterol and increased risk of all-cause death, myocardial infarction, and stroke.
Therefore, interest is focused on variability in total cholesterol as a factor that can be further considered to predict cardiovascular disease risk.
MACE incidence, high cholesterol volatility and low CEE group “13.1%”
Group with low cholesterol volatility and high CEE “4.7%”
▲Professor Joo Hyeong-jun of Korea University Anam Hospital.
This study aimed to investigate demographic characteristics associated with variability in total cholesterol and EEC and evaluate their impact on cardiovascular prognosis.
Based on multicenter retrospective data from three national tertiary medical institutions, total cholesterol was first measured between 2002 and 2007, and patients who were assessed three or more times over the next eight years were identified to construct a cohort containing a total of 4,413 patients.
After an 8-year modeling period, a 5-year follow-up was performed and we studied the occurrence of MACE, including all-cause death, myocardial infarction, and stroke.
The mean age was between 69 and 72 years, and the quartile group with the highest coefficient of variation (CV) of total cholesterol, which confirms variability, was the oldest at 72.5 years. Additionally, the quartile with the highest CV of total cholesterol had the highest rates of smoking or drinking.
As a result of the analysis, it was found that the quartile group with the highest CV of total cholesterol had a high incidence of not only MACE but also myocardial infarction, stroke, and death from all causes.
In contrast, CEE had the highest incidence of MACE, myocardial infarction, stroke, and all-cause death in the lowest quartile. This is assumed to be because the proportion of patients with diabetes and chronic kidney disease was high in the lowest CEE quartile group.
The analysis is that these people received disease management training and implemented lifestyle changes, including a strict diet, which lowered their serum cholesterol levels, which may have lowered their EEC in the phase of modeling the study. Professor Joo explained that the LDL cholesterol level was significantly lower in the group of diabetic patients compared to the group of patients without diabetes.
Subsequently, the incidence rate of MACE was higher, at 13.1%, in the group with high CV of total cholesterol and low CEE. This was followed by the group with an elevated CV of total cholesterol and an elevated CEE at 8.6%. The group with the lowest incidence of MACE was the group with a low total cholesterol CV and high CEE, at 4.7%.
Accordingly, as a result of the risk analysis of MACE adjusting for age, sex, smoking history, alcohol consumption and comorbidities, the group with a high CV of total cholesterol was 1.67 times that of the group with a low CV and a low CEE, and the group with a low CV and high CEE was 1.67 times higher It was significantly higher by 1.63 times. These findings suggest that high variability in total cholesterol is an independent predictor of MACE risk regardless of CEE.
On the other hand, the MACE risk in the high CEE group tended to be 22% lower than in the low CEE and low CV total cholesterol group and 24% lower than in the low CEE high CV group, but there was no statistical significance.
Professor Joo said: “The variability of total cholesterol may be more important than CEE in predicting worsening cardiovascular prognosis” and added: “Assessing the variability of total cholesterol may be useful in assessing future risk of cardiovascular disease and l clinical intervention to manage it”. “It can be considered a potential therapeutic target to be improved,” he underlined.
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