Comparison of the effects of triglyceride variability and exposure estimate on clinical prognosis in diabetic patients

Abstract

Background Hypertriglyceridemia is an important feature of dyslipidemia in type 1 and type 2 diabetic patients and associated with the development of atherosclerotic cardiovascular disease. Recently, variability of lipid profile has been suggested as a residual risk factor for cardiovascular disease. This study compared the clinical impact of serum triglyceride variability, and their cumulative exposure estimates on cardiovascular prognosis in diabetic patients. Methods A total of 25,933 diabetic patients who had serum triglyceride levels measured at least 3 times and did not have underlying malignancy, myocardial infarction (MI), and stroke during the initial 3 years (modeling phase) were selected from three tertiary hospitals. They were divided into a high/low group depending on their coefficient of variation (CV) and cumulative exposure estimate (CEE). Incidence of major adverse event (MAE), a composite of all-cause death, MI, and stroke during the following 5 years were compared between groups by multivariable analysis after propensity score matching. Results Although there was a slight difference, both the high CV group and the high CEE group had a higher cardiovascular risk profile including male-dominance, smoking, alcohol, dyslipidemia, and chronic kidney disease compared to the low groups. After the propensity score matching, the high CV group showed higher MAE incidence compared to the low CV group (9.1% vs 7.7%, p = 0.01). In contrast, there was no significant difference of MAE incidence between the high CEE group and the low CEE group (8.6% vs 9.1%, p = 0.44). After the multivariable analysis with further adjustment for potential residual confounding factors, the high CV was suggested as an independent risk predictor for MAE (HR 1.19 [95% CI 1.03–1.37]). Conclusion Visit-to-visit variability of triglyceride rather than their cumulative exposure is more strongly related to the incidence of MAE in diabetic patients.

Effects of metabolic parameters’ variability on cardiovascular outcomes in diabetic patients

“…Previously, the authors of the present study have shown that variability of triglyceride levels may be harmful in diabetic patients [ 9 ]. The presence of other metabolic profile variabilities in diabetic patients, and whether they independently exert influence on clinical outcomes is yet to be elucidated.…”

“…Regarding TG, high TG variability was recently shown to be an independent risk predictor for adverse cardiovascular outcomes including all-cause death and MI, as compared with cumulative exposure to high levels of TG [ 9 ]. While Koh et al evaluated TG as a single variable, this study consolidates the adverse effect of TG variability by analysing TG variability together with variabilities of other metabolic parameters.…”

Metabolic syndrome parameters' variability and stroke incidence in hypertensive patients: evidence from a functional community cohort

“…Previous investigations exploring lipid variability on stroke are limited, suggesting that variability in HDL-C levels may increase the risk of stroke and ischemic stroke, while no significant association was found for TG levels [ 19 – 21 ]. However, there is a 37% increase in mortality risk for individuals with high TG variability [ 20 ], suggesting a potential biological detriment to health with Tg variability. The impact of body weight fluctuation on stroke risk remains unclear.…”

Diagnostic value of triglyceride–glucose index and related parameters in metabolism-associated fatty liver disease in a Chinese population: a cross-sectional study

“…Hypertension was defined as SBP ≥140 mm Hg and/or DBP ≥90 mm Hg or the current use of antihypertensive medication. 27 Diabetes was defined as FPG ≥7.0 mmol/L or the current use of hypoglycaemic agents. 28 …”