Joint effect of visit-to-visit variability in LDL-cholesterol, HDL-cholesterol and HbA1c on cardiovascular and total mortality in patients with diabetes.

We aimed to investigate the joint effect of visit-to-visit variability (VVV) in low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides and glycosylated hemoglobin (HbA1c) on cardiovascular mortality and total mortality in patients with diabetes. Among 5194 participants with type 2 diabetes enrolled in the ACCORD lipid trial, VVVs of LDL-C, triglycerides, HDL-C, and HbA1c were assessed from baseline to 2 years of follow-up and expressed as coefficient of variation (CV). The study outcomes included cardiovascular mortality and all-cause mortality. Over a median follow-up of 3.0 years from the end of variability measurements at years 2, there were 305 (5.9%) cases of all-cause mortality, of which, 144 were cardiovascular causes. The positive relations between LDL-C CV and cardiovascular mortality were significantly stronger among participants with higher HDL-C CV (P for interaction = 0.023), and higher HbA1c CV (P for interaction = 0.015). However, there were no significant interactions between LDL-C CV and triglycerides CV (P for interaction = 0.591). Similar trends were found for all-cause mortality. Consistently, there were graded trends in the risk of mortality with the increasing numbers of higher CV of the three variables: LDL-C, HbA1c, and HDL-C (P for trend = 0.008 for cardiovascular mortality, and P for trend < 0.001 for all-cause mortality). VVVs in LDL-C, HDL-C, and HbA1c may jointly affect the risks of cardiovascular and all-cause mortality in diabetes patients. Those with higher CVs of all three variables had the highest risks of cardiovascular and all-cause mortality. The online version contains supplementary material available at 10.1186/s13098-022-00905-x.

我们旨在研究低密度脂蛋白胆固醇（LDL - C）、高密度脂蛋白胆固醇（HDL - C）、甘油三酯和糖化血红蛋白（HbA1c）的随访间变异性（VVV）对糖尿病患者心血管死亡率和全因死亡率的联合影响。 在参与ACCORD脂质试验的5194名2型糖尿病参与者中，从基线到2年随访期间对LDL - C、甘油三酯、HDL - C和HbA1c的随访间变异性进行了评估，并以变异系数（CV）表示。研究结果包括心血管死亡率和全因死亡率。 从第2年变异性测量结束后的中位随访3.0年期间，共有305例（5.9%）全因死亡病例，其中144例是心血管原因导致的。在HDL - C变异系数较高（交互作用P = 0.023）和HbA1c变异系数较高（交互作用P = 0.015）的参与者中，LDL - C变异系数与心血管死亡率之间的正相关关系明显更强。然而，LDL - C变异系数和甘油三酯变异系数之间没有显著的交互作用（交互作用P = 0.591）。在全因死亡率方面也发现了类似的趋势。一致地，随着LDL - C、HbA1c和HDL - C这三个变量中较高变异系数的数量增加，死亡风险呈现分级趋势（心血管死亡率趋势P = 0.008，全因死亡率趋势P < 0.001）。 LDL - C、HDL - C和HbA1c的随访间变异性可能共同影响糖尿病患者心血管和全因死亡的风险。这三个变量变异系数都较高的患者心血管和全因死亡的风险最高。 在线版本包含补充材料，可在10.1186/s13098 - 022 - 00905 - x获取。