Associations of visit-to-visit lipid variability with coronary artery calcification and cardiovascular event in statin-naïve Koreans

Aims This study investigated the association of visit-to-visit lipid variability with both coronary artery calcification (CAC) and cardiovascular event risk among statin-naïve individuals. Methods and results We conducted a cross-sectional analysis of 59 879 participants whose lipid profiles were measured 4-6 times before or on the day of CAC scanning and a cohort study of 85 359 individuals who underwent at least five lipid tests with additional follow-up to identify cardiovascular events. Lipid variability was quantified using standard deviation, coefficient of variation, and variability independent of the mean (VIM). Cardiovascular events were identified using self-reported coronary artery disease and stroke. Among lipid profiles, the highest quartile of low-density lipoprotein cholesterol (LDL-C) variability (VIM) showed a 1.42-fold increased CAC score [95% confidence interval (CI): 1.22-1.65] compared to the lowest quartile. Furthermore, the VIM for total cholesterol, triglyceride, and non-high-density lipoprotein cholesterol levels was positively associated with CAC scores. During a median follow-up of 2.8 years, 664 cases of cardiovascular events were identified. Among the lipid profiles, only LDL-C variability was associated with an increased risk of cardiovascular events, with a hazard ratio of 1.41 (95% CI: 1.13-1.75) for those with the highest VIM variability. Conclusion These findings suggest that visit-to-visit lipid variability is independently associated with subclinical coronary atherosclerosis and cardiovascular risk in statin-naïve individuals. Clinicians need to be aware of the potential implications of lipid variability and consider monitoring lipid fluctuations as part of a comprehensive cardiovascular risk assessment.