Author + information
- Received November 13, 2018
- Revision received February 15, 2019
- Accepted February 21, 2019
- Published online May 20, 2019.
- Franz H. Messerli, MDa,b,c,∗ (, )@SripalBangalore,
- Louis Hofstetter, MDa,
- Stefano F. Rimoldi, MDa,
- Emrush Rexhaj, MDa and
- Sripal Bangalore, MD, MHAd
- aDepartment of Cardiology and Clinical Research, University Hospital, Bern, Switzerland
- bJagiellonian University, Krakow, Poland
- cDivision of Cardiology, Mount Sinai Health Medical Center, Icahn School of Medicine, New York, New York
- dThe Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
- ↵∗Address for correspondence:
Dr. Franz H. Messerli, University Hospital, Inselspital, Freiburgstrasse 18, 3010 Bern, Switzerland.
• Variability of cardiovascular risk factors is associated with cardiovascular risk independent of absolute value.
• This is true for blood pressure, LDL, glycemia, and body weight, but not heart rate.
• Treatment should focus not only on reduction of absolute values, but also on their variability.
Until recently, intraindividual visit-to-visit variability of cardiovascular risk factors has been dismissed as random fluctuation. This simplistic concept was challenged by demonstrating that visit-to-visit blood pressure variability, independent of average blood pressure, was a powerful risk factor for stroke. Subsequently, variability of other cardiovascular risk factors such as cholesterol, glycemia, and body weight was documented to increase risk independent of their absolute values. Variability of these risk factors has been demonstrated to be a powerful predictor for all-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease, and dementia. With the notable exception of heart rate, cardiovascular risk factors must now be defined by 2 components: the magnitude and duration of sustained risk factor elevation and, equally important, the variability of the same risk factor over time.
Dr. Messerli has served as a consultant or advisor for Daiichi-Sankyo, Pfizer, Abbott Vascular, Servier, Medtronic, WebMD, Menarini, Ipca, Hikma, the American College of Cardiology, Relypsa, and Sandoz. Dr. Rimoldi has had consultant or advisory relationships with Servier, Menarini, and Takeda; and has been on the Speakers Bureau for Menarini and Servier. Dr. Bangalore has served on Advisory Boards for Abbott Vascular, Daiichi-Sankyo, The Medicines Company, and Pfizer; has received research grants from Abbott Vascular and the National Heart, Lung, and Blood Institute (U01HL117905); and has received honoraria from Abbott, Abbott Vascular, AstraZeneca, Boehringer Ingelheim, Daiichi-Sankyo, Merck, and Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Steven E. Nissen, MD, served as Guest Associate Editor for this paper.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received November 13, 2018.
- Revision received February 15, 2019.
- Accepted February 21, 2019.
- 2019 American College of Cardiology Foundation
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