Total cholesterol variability and risk of atrial fibrillation: A nationwide population-based cohort study

• Published in: PloS one 2019-04, Vol.14 (4), p.e0215687-e0215687
• Main Authors: Roh, Eun, Chung, Hye Soo, Lee, Ji Sung, Kim, Jung A, Lee, You-Bin, Hong, So-Hyeon, Kim, Nam Hoon, Yoo, Hye Jin, Seo, Ji A, Kim, Sin Gon, Kim, Nan Hee, Baik, Sei Hyun, Choi, Kyung Mook
• Format: Article
• Language: English
• Subjects: Adult; Adults; Aged; Analysis; Analysis of Variance; Atherosclerosis; Atrial fibrillation; Atrial Fibrillation - blood; Atrial Fibrillation - epidemiology; Atrial Fibrillation - etiology; Body mass; Body mass index; Body size; Cardiac arrhythmia; Cardiovascular disease; Cardiovascular diseases; Cholesterol; Cholesterol - blood; Chronic obstructive pulmonary disease; Cohort analysis; Cohort Studies; Confidence intervals; Data collection; Diabetes; Endocrinology; Female; Fibrillation; Hazard assessment; Health; Health risk assessment; Health risks; Health screening; Heart; Heart failure; Humans; Hypercholesterolemia - blood; Hypercholesterolemia - complications; Hypercholesterolemia - epidemiology; Incidence; Insurance; Internal medicine; Kaplan-Meier Estimate; Lipids; Male; Medical research; Medical screening; Medicine; Metabolic disorders; Metabolism; Middle Aged; Mortality; National health insurance; Population; Population studies; Population-based studies; Proportional Hazards Models; Republic of Korea - epidemiology; Risk analysis; Risk Factors; Standard deviation; Statistical analysis; Studies; Subgroups; Variability; Variance analysis
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0215687

Long-term variability of cardiometabolic risk factors have been suggested as the risk factors for cardiovascular disease and mortality. However, the effect of long-term variability of total cholesterol (TC) on incident atrial fibrillation (AF) has not been examined. We explored whether visit-to-visit TC variability are associated with the risk of incident AF in 160,165 Korean adults, using the population-based Korean National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) database, over a median duration of 8.4 years. TC variability was measured as coefficients of variance (TC-CV), standard deviation (TC-SD), and variability independent of the mean (TC-VIM). Kaplan-Meier analysis demonstrated a decreased disease-free probability in the highest quartile group of TC variability compared to that in the other groups. In the multivariate Cox proportional hazard analysis, the risk of AF increased significantly in the highest quartile group of TC variability. After multivariate adjustment for confounding variables including mean TC levels, the hazard ratio for incident AF was 1.15 (95% confidence interval 1.05-1.25; P = 0.0035) when comparing the highest with the lowest TC variability quartile (TC-CV). These relationships were consistent with TC variability defined using TC-SD or TC-VIM. Subgroup analyses, including age, sex, body mass index, and cardiometabolic disorders, showed similar results. The present study is the first to demonstrate that high TC variability was associated with an increased risk of AF.