Variability in Lipid Levels and Risk for Cardiovascular Disease: An Electronic Health Record–Based Population Cohort Study

Sheila M. Manemann, Suzette J. Bielinski, Ethan D. Moser, Jennifer L. St. Sauver, Paul Y. Takahashi, Véronique L. Roger, Janet E. Olson, Alanna M. Chamberlain, Alan T. Remaley, Paul A. Decker, Jill M. Killian, Nicholas B. Larson

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND: Larger within-patient variability of lipid levels has been associated with increased risk of cardiovascular disease (CVD); however, measures of lipid variability require ≥3 measurements and are not currently used clinically. We investigated the feasibility of calculating lipid variability within a large electronic health record–based population cohort and assessed associations with incident CVD. METHODS AND RESULTS: We identified all individuals ≥40 years of age who resided in Olmsted County, MN, on January 1, 2006 (index date), without prior CVD, defined as myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention, or CVD death. Patients with ≥3 measurements of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or triglycerides during the 5 years before the index date were retained. Lipid variability was calculated using variability independent of the mean. Patients were followed through December 31, 2020 for incident CVD. We identified 19 652 individuals (mean age 61 years; 55% female), who were CVD-free and had variability independent of the mean calculated for at least 1 lipid type. After adjustment, those with highest total cholesterol variability had a 20% increased risk of CVD (Q5 versus Q1 hazard ratio, 1.20 [95% CI, 1.06–1.37]). Results were similar for low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. CONCLUSIONS: In a large electronic health record–based population cohort, high variability in total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol was associated with an increased risk of CVD, independent of traditional risk factors, suggesting it may be a possible risk marker and target for intervention. Lipid variability can be calculated in the electronic health record environment, but more research is needed to determine its clinical utility.

Original languageEnglish (US)
Article numbere8139
JournalJournal of the American Heart Association
Issue number5
StatePublished - Mar 7 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2023 The Authors and Mayo Clinic. Published on behalf of the American Heart Association, Inc., by Wiley.


  • LDL
  • cholesterol
  • epidemiology
  • triglycerides


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