Visit-to-visit variability of metabolic parameters and progression of atherosclerosis in computed tomography: follow up of an asymptomatic cohort

BACKGROUND: We aimed to examine whether intra-individual variability in traditional risk factors affects the progression of atherosclerosis on subsequent coronary computed tomography angiography (CCTA). METHODS: We conducted a retrospective cohort study using asymptomatic health examination cohort data from Haeundae Paik Hospital in Korea collected between 2010–2020. A total of 387 adults met the inclusion criteria of having at least two CCTAs without specific symptoms with an interval of more than one year and having completed three or more health examinations. Visit-to-visit variability was evaluated using the average real variability (ARV) of body mass index, waist circumference, systolic and diastolic blood pressure, and plasma glucose, total cholesterol, triglyceride, high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol. Progression of coronary artery atherosclerosis was defined as worsening of coronary artery stenosis from baseline to final CCTA. ARV values for various metabolic parameters were stratified into quartiles, and hazard ratios (HRs) and 95% confidence intervals (CIs) for coronary atherosclerosis progression were analyzed using multiple Cox proportional hazards models. RESULTS: There were 126 cases of coronary artery stenosis progression (32.56%) assessed using the Coronary Artery Disease Reporting and Data System during a mean follow up of 3.91 (range, 1–9) years. In the multivariate analysis comparing ARV quartiles for LDL-cholesterol after adjusting for covariates, individuals with higher variability showed an increased risk of stenosis progression: HR 2.23 (95% CI: 1.33–3.73) for the third quartile, HR 1.56 (95% CI: 0.91–2.66) for the fourth quartile (P for trend =0.005). Triglycerides also showed a significant linear trend (P for trend =0.04), and Q4 had a greater risk of stenosis progression (HR, 2.09; 95% CI: 1.24–3.52). Meanwhile, the risk of stenosis progression was significantly reduced as the ARV of HDL-cholesterol increased: HR 0.56 (95% CI: 0.35–0.89) for the third quartile, HR 0.47 (95% CI: 0.27–0.81) for the fourth quartile (P for trend =0.01). CONCLUSIONS: High variability in LDL-cholesterol and triglyceride was an independent predictor of coronary artery stenosis progression on subsequent CCTA in our cohort. This finding highlights the importance of maintaining stable state to effectively prevent the progression of coronary artery stenosis in clinical settings.