The association between visit-to-visit variability in risk factors and incident cardiovascular disease: a <i>post hoc</i> analysis of the Multi-Ethnic Study of Atherosclerosis

Our aim is to investigate the association between visit-to-visit variability of nine risk factors and incident cardiovascular disease (CVD) in a large multi-ethnic population cohort study. We used the Multi-Ethnic Study of Atherosclerosis cohort. We included individuals with no previous history of CVD, with at least three repeated measurements on each risk factor including total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, triglyceride, Chol/HDL-C ratio, diastolic blood pressure, systolic blood pressure (SBP), and body mass index (BMI). Visit-to-visit variability was estimated via the variability independent of the mean. A Cox proportional hazards model was used to estimate the association between visit-to-visit variability and the hazard of developing CVD. There was a statistically significant association between visit-to-visit variability in SBP, BMI, HDL-C, and the rate of incident CVD. This rate was higher in individuals with high visit-to-visit variability for SBP (HR, 1.28; 95% CI, 1.01-1.63; P = .04), BMI (HR, 1.58; 95% CI, 1.25-2.00; P < .001), and HDL-C (HR, 1.3; 95% CI, 1.03-1.65; P = .025), compared to those with low visit-to-visit variability. Our findings suggest that visit-to-visit variability in some CVD risk factors could be independently associated with incident CVD and may be useful to clinicians in risk stratification.