Effects of BMI and LDL-cholesterol change pattern on cardiovascular disease in normal adults and diabetics

Abstract

IntroductionTo examine how the risk of cardiovascular disease changes according to degree of change in body mass index (BMI) and low-density lipoprotein (LDL)-cholesterol in patients with diabetes using the health medical examination cohort database of the National Health Insurance Service in Korea. In comparison, the pattern in a non-diabetic control group was also examined.Research design and methodsThe study samples were 13 800 patients with type 2 diabetes and 185 898 non-diabetic controls, and their baseline characteristics and repeatedly measured BMI and LDL-cholesterol until occurrence of cardiovascular disease were collected in longitudinal data. We used the variability model that is joint of mixed effects and regression model, then estimated parameters about variability by Bayesian methods.ResultsThe risk of cardiovascular disease was increased significantly with high average real variability (ARV) of BMI in the patients with diabetes, but the risk of cardiovascular disease was not increased according to degree of ARV in non-diabetic controls. The Bayesian variability model was used to analyze the effects of BMI and LDL-cholesterol change pattern on development of cardiovascular disease in diabetics, showing that variability did not have a statistically significant effect on cardiovascular disease. This shows the danger of the former simple method when interpreting only the mean of the absolute value of the variation.ConclusionsThe approach of simple SD in previous studies for estimation of individual variability does not consider the order of observation. However, the Bayesian method used in this study allows for flexible modeling by superimposing volatility assessments on multistage models.

Weight variability and cardiovascular outcomes: a systematic review and meta-analysis

“…This method had three notable exceptions, where one report of ischaemic heart disease deaths [ 10 ], one report of cerebrovascular deaths [ 10 ], and two reports of coronary heart disease deaths [ 11 ], have been included in the cardiovascular death analysis. Similarly, two separate studies recorded RRs for CVD, and these reports have been treated as a compound outcomes and thus included in the most composite CVD outcome analysis [ 6 , 12 ].…”

“…Weight cycling was defined and measured in studies via 2 different measures: categorical and continuous. Continuous definitions included CoV [ 11 , 13 , 20 ], ASV [ 4 , 5 , 12 , 14 , 25 , 27 ], RMSE [ 10 , 26 ], SD [ 15 ], and VIM [ 16 – 19 , 21 ]. Categorical definitions included a BMI loss of ≥ 2 followed by a gain of ≥ 2 or vice-versa [ 6 ], a weight loss of at least 10 lbs (4.5 kg) at least 3 times [ 22 ], a BMI loss of ≥ 4% from baseline to midpoint follow-up and then a BMI gain of ≥ 4% from midpoint follow-up to last visit or vice-versa [ 7 ], a sum of deviations > 5.04 for those with < 3.0 unit difference from their initial to final BMI [ 23 ], being in the top quintile of VIM-defined body-weight variability [ 8 ], and experiencing a loss then a gain in body weight or vice versa [ 24 ].…”

Lipid variability and risk of microvascular complications in Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: A post hoc analysis

“…Of note is that a study using a large sample of Korean participants with T2DM ( n = 13 800) and nondiabetic controls ( n = 185 898) observed a nonsignificant association between higher variability of LDL (measured by average real variability) and CVD. 32 Similarly, in a recent 5‐year follow‐up study of 4475 nondiabetic Chinese participants, the researchers found a nonsignificant association between LDL variability and incident T2DM. 33 Further studies may be necessary to clarify the discordant results of the relationship of LDL variability with adverse health outcomes, including renal function decline.…”

“…The reason for this unexpected null association is unknown, but we could speculate that because some participants received lipid treatment with the aim of maintaining good control of LDL levels, the potentially harmful effect of high variability in LDL may have been mitigated. Of note is that a study using a large sample of Korean participants with T2DM ( n = 13 800) and nondiabetic controls ( n = 185 898) observed a nonsignificant association between higher variability of LDL (measured by average real variability) and CVD 32 . Similarly, in a recent 5‐year follow‐up study of 4475 nondiabetic Chinese participants, the researchers found a nonsignificant association between LDL variability and incident T2DM 33 .…”

Dietary Magnesium Intake Affects the Vitamin D Effects on HOMA-β and Risk of Pancreatic β-Cell Dysfunction: A Cross-Sectional Study

“…After the completion of the measurements, pounds were converted into kg. The formula for BMI is: BMI = weight (kg)/height (M2) ( 39 ). The dietary data came from diet recall interviews in the first 24 h, including total dietary energy, Vit D, calcium, magnesium, protein and fiber.…”