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

Abstract

Background Metabolic abnormalities such as dyslipidemia, glucose and high blood pressure are common in diabetic patients. Visit-to-visit variabilities in these measures have been reported as potential residual cardiovascular risk factors. However, the relationship between these variabilities and their effects on cardiovascular prognosis have not been studied. Methods A total of 22,310 diabetic patients with ≥ 3 measurements of systolic blood pressure (SBP), blood glucose, total cholesterol (TC), and triglyceride (TG) levels during a minimum of three years at three tertiary general hospitals were selected. They were divided into high/low variability groups for each variable based on the coefficient of variation (CV) values. The primary outcome was the incidence of major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, and stroke. Results All high CV groups had a higher incidence of MACE than those with low CV (6.0% vs. 2.5% for SBP-CV groups, 5.5% vs. 3.0% for TC-CV groups, 4.7% vs. 3.8% for TG-CV groups, 5.8% vs. 2.7% for glucose-CV groups). In multivariable Cox regression analysis,, high SBP-CV (HR 1.79 [95% CI 1.54–2.07], p < 0.01), high TC-CV (HR 1.54 [95% CI 1.34–1.77], p < 0.01), high TG-CV (HR 1.15 [95% CI 1.01–1.31], p = 0.040) and high glucose-CV (HR 1.61 [95% CI 1.40–1.86], p < 0.01) were independent predictors of MACE. Conclusion Variability of SBP, TC, TG and glucose are important residual risk factors for cardiovascular events in diabetic patients.

Value of glycemic dispersion index in predicting major adverse cardiovascular events in diabetic patients with concomitant acute coronary syndrome

“…However, the study results showed that TG, LDL, and Hs-CRP are protective factors, which is inconsistent with conventional beliefs. In the studies conducted by Subin Lim [21] and Marjo Okkonen [23], an inverse relationship between plasma lipids and the risk of MACE occurrence was also observed. Some scholars believe that this may be related to higher cardiovascular disease prevention and treatment awareness among patients with elevated plasma lipid levels.…”

“…The results of the study conducted by Lim S [21] suggest that higher glycemic variability is a signi cant risk factor for MACE in diabetic patients. Sungha Park [22] found that higher glycemic variability during hospitalization was associated with allcause mortality within one year in diabetic patients with comorbid cardiovascular disease.…”

Associations of variability in body mass index with cardiovascular outcomes in the general population: A systematic review

“…Future research must clarify the precise mechanisms by which the variability of several parameters influences one another. 24 …”

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

“…Additionally, a population-based study suggested that the high number of variabilities in WC, FBG, SBP, TG, and HDL-C elevated cardiovascular disease risk [ 26 ]. The association was also noted among diabetic patients, with the metabolic parameters' variability under evaluation being SBP, FBG, TC, and TG [ 28 ]. One study examined the association between the variability of metabolic parameters, comprising SBP, BMI, FBG, and TC, and mortality among individuals in a Chinese population [ 27 ].…”