1285-P: Variability of Lipid Measures and Risk of Heart Failure Events—Findings from the ALLHAT Trial

Introduction: The role of long-term variation in lipids in risk for cardiovascular events has been inadequately explored. We used data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack (ALLHAT) trial to explore the association between variability of plasma lipids and heart failure (HF).

Methods: Variability in lipid parameters was computed as coefficient of variation (i.e. CV-Chol, CV-LDL, CV-HDL, and CV-Trig). HF events were adjudicated by the ALLHAT endpoint committee. Participants with three or more fasting lipid readings were included. Time-dependent Cox regression models were used to compute hazard ratios (HR) assessing the associations between variability and HF.

Results: In ALLHAT, 4,189 participants reported three or more fasting lipid measures. HF was reported in 173 participants in this cohort. In unadjusted Cox models, variability of total cholesterol (CV-Chol) was associated with HF (HR = 1.23, p = 0.0006). This association was somewhat attenuated (HR = 1.22, p = 0.001) when adjusting for mean cholesterol levels. The association with total cholesterol was driven by a significant association with CV-LDL (p = 0.03) but not HDL. CV-Trig was not associated with HF in ALLHAT (p = 0.90).

Conclusions: Building on findings in some prior clinical trials, long-term variability in total cholesterol levels was linked to risk of HF in ALLHAT. These findings require further investigation in epidemiologic and real-world settings. Efforts to understand the mechanisms that link lipid variability to cardiovascular disease are also warranted.